Birth by Caesarean Section and Offspring Overweight and Obesity in Adult Life: A Systematic Review and Meta-analysis

Overweight/obesity is one of the most important health problem worldwide. Birth by cesarean section has been shown to influence long-term health outcome including obesity. The aim of this systematic review-meta-analysis is to examine whether cesarean section increases the risk of offspring’ s overweight/obesity. The study follows the PRISMA and MOOSE guidelines. A systematic literature search was con-ducted on Scopus, PubMed, and WoS until December 2020. For inclusion, studies must have re-ported either (I) both Birth by cesarean section and adult (≥ 18 years) offspring BMI, (II) cohort or case–control study design and (III) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger’s test and Begg’s test. Me-ta-analysis was performed through a random effect model. Eleven studies with a combined population of 180.408 subjects were included in the meta-analysis. The overall analysis (n = 18) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI 1.08-1.31) and the test of heterogeneity resulted Q=53,37 (I2 = 70,37 %, P≤0•0001). The risk of offspring obesity is 1.23 (95% CI 1.09-1.39) and the test of heterogeneity resulted Q=39.50 (I2= 72,15%, P≤0•0001). Children born by cesarean section have an increased risk of developing obesity in adulthood