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ABSTRACT Studies have reported inconsistent results concerning the association of cesarean section with offspring obesity. We performed a systematic review and meta-analysis to examine

whether cesarean section increases the risk of later overweight and obesity. Pubmed, Embase and Web of Science were searched using different combinations of two groups of keywords:

‘cesarean’ and ‘overweight/obesity’. Cohort or case–control studies that reported the association of cesarean section with childhood (3–8 years), adolescence (9–18 years) and/or adult

(>19 years) overweight/obesity were eligible. Where possible, adjusted risk estimates were pooled using a random effects model; otherwise unadjusted estimates were pooled. Statistical

heterogeneity was assessed with _I_2 statistics; the values of 25%, 50% and 75% were considered to indicate low, medium and high heterogeneity, respectively. We conducted a subgroup analysis

to identify the sources of heterogeneity according to study quality defined on the basis of the Newcastle-Ottawa Scale. In total, two case–control and seven cohort studies were identified

for the literature review and 15 separate risk estimates were included in the meta-analysis. The overall pooled odds ratio (OR) of overweight/obesity for offspring delivered by cesarean

section compared with those born vaginally was 1.33 (95% confidence interval (CI) 1.19, 1.48; _I_2=63%); the OR was 1.32 (1.15, 1.51) for children, 1.24 (1.00, 1.54) for adolescents and 1.50

(1.02, 2.20) for adults. In subgroup analysis, the overall pooled OR was 1.18 (1.09, 1.27; _I_2=29%) for high-quality studies and 1.78 (1.43, 2.22; _I_2=24%) for medium-quality (_P_ for

interaction=0.0005); no low-quality studies were identified. The ORs for children, adolescents and adults all tended to be lower for high-quality studies compared with medium-quality

studies. Our results indicated that cesarean section was moderately associated with offspring overweight and obesity. This finding has public health implications, given the increase in

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our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS MATERNAL ADIPOSITY AND PERINATAL AND OFFSPRING OUTCOMES: AN UMBRELLA REVIEW Article 11 October 2024 SYSTEMATIC

REVIEW AND META-ANALYSIS OF THE ASSOCIATION BETWEEN YOUNG MATERNAL AGE AND FETAL ABNORMALITIES Article Open access 29 September 2024 EVALUATING THE ASSOCIATION BETWEEN CAESAREAN DELIVERY AND

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center: Obesity and overweight (accessed 11 July 2012, at http://www.who.int/mediacentre/factsheets/fs311/en/index.html). Download references ACKNOWLEDGEMENTS We thank Dr Mary K Serdula and

Ji Liu for their review and editing of this manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of

Reproductive Health, School of Public Health, Peking University Health Science Center, Beijing, China H-t Li, Y-b Zhou & J-m Liu * Department of Epidemiology and Biostatistics, School of

Public Health, Peking University Health Science Center, Beijing, China H-t Li, Y-b Zhou & J-m Liu Authors * H-t Li View author publications You can also search for this author inPubMed 

Google Scholar * Y-b Zhou View author publications You can also search for this author inPubMed Google Scholar * J-m Liu View author publications You can also search for this author inPubMed

 Google Scholar CORRESPONDING AUTHOR Correspondence to J-m Liu. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Li, Ht., Zhou, Yb. & Liu, Jm. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis.

_Int J Obes_ 37, 893–899 (2013). https://doi.org/10.1038/ijo.2012.195 Download citation * Received: 21 June 2012 * Revised: 01 October 2012 * Accepted: 29 October 2012 * Published: 04

December 2012 * Issue Date: July 2013 * DOI: https://doi.org/10.1038/ijo.2012.195 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable

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offspring * systematic review * meta-analysis