Cesarean Delivery on Maternal Request and Common Child Health Outcomes: A Prospective Cohort Study

Cesarean delivery (CD) versus vaginal delivery was reported to increase the risks of childhood obesity, pneumonia, anemia, and neurobehavioral disorders, but few studies were able to deal with the confounding biases associated with medical conditions indicating cesareans. This prospective cohort study aims to investigate the associations of non-medically indicated CD on maternal request (CDMR) with multiple child health outcomes. Among live-born infants whose mothers participated in a randomized controlled trial on micronutrient supplementation and pregnancy outcomes during 2006-2009 in 5 rural counties in Hebei Province, China, 6972 singletons born by full-term spontaneous vaginal delivery (SVD) and 3626 by CDMR were selected and followed up at 1.5-5 years in 2011. The primary outcome was obesity, defined as a weight-for-height z-score >3. The secondary outcomes included self-reported pneumonia, anemia defined as hemoglobin <110 g/L, and neurobehavioral disorders identified by Child Behavior Checklist and Bayley Scales of Infant Development. Compared with SVD, CDMR was associated with increased risks of obesity (adjusted odds ratio [aOR] 1.41; 95% confidence interval [CI] 1.14-1.75) and anemia (aOR 1.65; 95% CI 1.28-2.12), but not with the risk of pneumonia (aOR 1.16; 95% CI 0.94-1.45) or neurobehavioral disorders (aORs varied from 0.82 to 1.13) in childhood. Conclusion: CD, independent of cesarean indications, is likely associated with childhood obesity and anemia, indicating a need to keep pregnant women informed, especially those seeking CDMR, a need to explore possible improvement on obstetric service, and even a need for main stakeholders to reach a compromise in making a cesarean decision.