{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:31:37Z","timestamp":1787319097957,"version":"build-2736575974"},"reference-count":0,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"abstract":"<jats:sec id=\"s1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most studies assessing the association between caesarean delivery (CD) and childhood overweight\/obesity have failed to account for important confounders, such as maternal prepregnancy body mass index (BMI) or the indication of the CD. Furthermore, within-family analyses have reported contradictory results. We aimed at evaluating the association between CD and offspring\u2019s risk of overweight\/obesity while adjusting for important confounders and accounting for correlations between siblings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s2\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women in the \u2018Seguimiento Universidad de Navarra\u2019 cohort provided structured information regarding their pregnancy history and their children\u2019s health through online cross-sectional questionnaires. We calculated adjusted differences in BMI z-score and risk ratios (RR) for offspring\u2019s overweight\/obesity associated with CD, with hierarchical models to account for correlations between siblings. We also performed a within-family analysis in 341 siblings who were discordant in delivery mode, using conditional multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 2791 children analysed, those born by CD had higher average BMI z-scores (difference: 0.17; 95% CI 0.07 to 0.27) and higher risk of overweight\/obesity (RR: 1.32, 95% CI 1.05 to 1.65) than children born vaginally. The association did not differ by maternal characteristics or offspring\u2019s age strata, and the results were consistent in sensitivity analyses. Furthermore, within-family analysis showed that children born by CD had 2.67-fold higher risk of overweight\/obesity (95% CI 1.10 to 5.12) than their peers born vaginally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s4\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Children born by CD have higher average BMI z-scores and higher risk of overweight\/obesity than children born vaginally. The consistency of these findings across multiple approaches to address potential residual confounding likely suggests a true biological effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2019-213724","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T17:19:40Z","timestamp":1587748780000},"page":"jech-2019-213724","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Caesarean delivery is associated with higher risk of overweight in the offspring: within-family analysis in the SUN cohort"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7549-1455","authenticated-orcid":false,"given":"Nerea","family":"Mart\u00edn-Calvo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel","family":"Mart\u00ednez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Segura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge E","family":"Chavarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Carlos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Gea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,4,24]]},"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2019-213724","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T12:12:47Z","timestamp":1601035967000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2019-213724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,24]]},"references-count":0,"alternative-id":["10.1136\/jech-2019-213724"],"URL":"https:\/\/doi.org\/10.1136\/jech-2019-213724","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,24]]}}}