{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:27:28Z","timestamp":1791214048842,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Elective cesarean section (ECS) primarily contributes to the rising cesarean section (CS) rate, and much attention has been attracted to its health consequences. The association between ECS and overweight and obesity in children has been controversial, and few studies distinguished ECS with medical indications from those without indications. Based on a large sample birth cohort, we aim to examine the association of ECS with or without medical indications on children's physical development by using repeated anthropometric data from birth to 6 years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 2304 mother-child pairs with complete data on delivery mode and children's anthropometric measurements were recruited from the Ma'anshan-Anhui Birth Cohort (MABC) in China. ECS was the main exposure in this study, and the primary outcomes were children's growth trajectories and early adiposity rebound (AR). Children's BMI trajectories were fitted by using group-based trajectory models and fractional polynomial mixed-effects models. The association between ECS and children's growth trajectories and early AR was performed using multiple logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2,304 mother-child pairs (1199 boys and 1105 girls), 1088 (47.2%) children were born by CS, including 61 (5.6%) emergency CS, 441 (40.5%) ECS with medical indications, and 586 (53.9%) ECS without medical indications. After adjusting for potential confounders, it was found that ECS with medical indications was associated with a \u201chigh level\u201d of BMI trajectory (OR = 1.776; 95% CI: 1.010\u20133.123), and ECS without medical indications was associated with early AR (OR = 1.517; 95% CI: 1.123\u20132.050) in girls. In boys, we found that ECS without medical indications was unlikely to experience an accelerated growth trajectory (OR = 0.484; 95%CI: 0.244\u20130.959).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ECS may be related to girls' \u201chigh level\u201d BMI trajectories and early AR. If causal, the findings will provide an evidence-based reference for early life interventions for childhood obesity.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.985851","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T09:29:25Z","timestamp":1663666165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Sex-specific association between elective cesarean section and growth trajectories in preschool children: A prospective birth cohort study"],"prefix":"10.3389","volume":"10","author":[{"given":"Shanshan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jixing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengting","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyong","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangbiao","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: global and regional estimates","volume":"6","author":"Betran","year":"2021","journal-title":"BMJ Glob Health."},{"key":"B2","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1001\/jama.2019.17595","article-title":"Trends in Cesarean delivery rates in China, 2008-2018","volume":"323","author":"Li","year":"2020","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1186\/s12884-021-03866-7","article-title":"Cesarean delivery on maternal request and its influencing factors in Chongqing, China","volume":"21","author":"Deng","year":"2021","journal-title":"BMC Pregnancy Childbirth."},{"key":"B4","volume-title":"WHO Statement on Caesarean Section Rates","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1016\/S0140-6736(18)31930-5","article-title":"Short-term and long-term effects of caesarean section on the health of women and children","volume":"392","author":"Sandall","year":"2018","journal-title":"Lancet."},{"key":"B6","year":"","journal-title":"Obesity and Overweight."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1038\/s41366-018-0239-2","article-title":"Does cesarean delivery impact infant weight gain and adiposity over the first year of life?","volume":"43","author":"Mueller","year":"2019","journal-title":"Int J Obes (Lond)."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e162385","DOI":"10.1001\/jamapediatrics.2016.2385","article-title":"Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood","volume":"170","author":"Yuan","year":"2016","journal-title":"JAMA Pediatr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1093\/qjmed\/hcy195","article-title":"Cesarean section and risks of overweight and obesity in school-aged children: a population-based study","volume":"111","author":"Chu","year":"2018","journal-title":"QJM."},{"key":"B10","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s12884-016-1131-5","article-title":"Cesarean section may increase the risk of both overweight and obesity in preschool children","volume":"16","author":"Rutayisire","year":"2016","journal-title":"BMC Pregnancy Childbirth."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e025051","DOI":"10.1136\/bmjopen-2018-025051","article-title":"Association between caesarean section delivery and obesity in childhood: a longitudinal cohort study in Ireland","volume":"9","author":"Masukume","year":"2019","journal-title":"BMJ Open."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e185025","DOI":"10.1001\/jamanetworkopen.2018.5025","article-title":"Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age","volume":"1","author":"Cai","year":"2018","journal-title":"JAMA Netw Open."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1136\/jech-2019-212591","article-title":"Caesarean section delivery and childhood obesity: evidence from the growing up in New Zealand cohort","volume":"73","author":"Masukume","year":"2019","journal-title":"J Epidemiol Community Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1093\/ajcn\/39.1.129","article-title":"Adiposity rebound in children: a simple indicator for predicting obesity","volume":"39","author":"Rolland-Cachera","year":"1984","journal-title":"Am J Clin Nutr."},{"key":"B15","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1111\/obr.12842","article-title":"Group-based trajectory modelling for BMI trajectories in childhood: a systematic review","volume":"20","author":"Mattsson","year":"2019","journal-title":"Obes Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta19430","article-title":"The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis","volume":"19","author":"Simmonds","year":"2015","journal-title":"Health Technol Assess."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1542\/peds.2013-0966","article-title":"Adiposity rebound and the development of metabolic syndrome","volume":"133","author":"Koyama","year":"2014","journal-title":"Pediatrics."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1038\/ijo.2014.97","article-title":"Early adiposity rebound is associated with metabolic risk in 7-year-old children","volume":"38","author":"Gonz\u00e1lez","year":"2014","journal-title":"Int J Obes (Lond)."},{"key":"B19","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1093\/ije\/dyy286","article-title":"Patterns of body mass index milestones in early life and cardiometabolic risk in early adolescence","volume":"48","author":"Aris","year":"2019","journal-title":"Int J Epidemiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1038\/ijo.2013.165","article-title":"How do changes in body mass index in infancy and childhood associate with cardiometabolic profile in adulthood? Findings from the Northern Finland Birth Cohort 1966 Study","volume":"38","author":"Sovio","year":"2014","journal-title":"Int J Obes (Lond)."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1038\/s41366-022-01120-4","article-title":"Age at adiposity rebound and the relevance for obesity: a systematic review and meta-analysis","volume":"46","author":"Zhou","year":"2022","journal-title":"Int J Obes (Lond)."},{"key":"B22","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1097\/00001648-199901000-00008","article-title":"Causal diagrams for epidemiologic research","volume":"10","author":"Greenland","year":"1999","journal-title":"Epidemiology."},{"key":"B23","first-page":"431","article-title":"Prospective study for cut-off points of body mass index in Chinese adults","volume":"6","year":"2002","journal-title":"Chin J Epidemiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.jpeds.2018.05.041","article-title":"Pre-, perinatal, and parental predictors of body mass index trajectory milestones","volume":"201","author":"Aris","year":"2018","journal-title":"J Pediatr"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1038\/s41366-021-00847-w","article-title":"Association between perinatal factors, genetic susceptibility to obesity and age at adiposity rebound in children of the EDEN mother-child cohort","volume":"45","author":"Ciss\u00e9","year":"2021","journal-title":"Int J Obes (Lond)."},{"key":"B26","doi-asserted-by":"crossref","DOI":"10.4159\/9780674041318","volume-title":"Group-Based Modeling of Development","author":"Nagin","year":"2005"},{"key":"B27","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/1471-2288-12-38","article-title":"Childhood body mass index trajectories: modeling, characterizing, pairwise correlations and socio-demographic predictors of trajectory characteristics","volume":"12","author":"Wen","year":"2012","journal-title":"BMC Med Res Methodol."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.625853","article-title":"Chen J. Rapid BMI increases and persistent obesity in small-for-gestational-age infants","author":"Wu","year":"2021","journal-title":"Front Pediatr"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1038\/s41366-021-00892-5","article-title":"Infant feeding and growth trajectories in early childhood: the application and comparison of two longitudinal modelling approaches","volume":"45","author":"Zheng","year":"2021","journal-title":"Int J Obes (Lond)."},{"key":"B30","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1093\/ajcn\/nqx058","article-title":"Breastfeeding and complementary feeding in relation to body mass index and overweight at ages 7 and 11 y: a path analysis within the Danish National Birth Cohort","volume":"107","author":"Morgen","year":"2018","journal-title":"Am J Clin Nutr."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e12769","DOI":"10.1111\/ijpo.12769","article-title":"Associations of caesarean section with body mass and waist circumference trajectories from age 2 to 13 years: a nationally representative birth cohort study in Australia","volume":"16","author":"Begum","year":"2021","journal-title":"Pediatr Obes."},{"key":"B32","doi-asserted-by":"publisher","first-page":"598016","DOI":"10.3389\/fped.2020.598016","article-title":"Associations between delivery mode and early childhood body mass index Z-score trajectories: a retrospective analysis of 2,685 children from mothers aged 18 to 35 years at delivery","volume":"8","author":"Zhang","year":"2020","journal-title":"Front Pediatr"},{"key":"B33","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1136\/gutjnl-2012-303249","article-title":"Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section","volume":"63","author":"Jakobsson","year":"2014","journal-title":"Gut."},{"key":"B34","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1038\/s41586-019-1560-1","article-title":"Stunted microbiota and opportunistic pathogen colonization in caesarean-section birth","volume":"574","author":"Shao","year":"2019","journal-title":"Nature."},{"key":"B35","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1089\/chi.2018.0040","article-title":"Childhood obesity and firmicutes\/bacteroidetes ratio in the gut microbiota: a systematic review","volume":"14","author":"Indiani","year":"2018","journal-title":"Child Obes."},{"key":"B36","doi-asserted-by":"publisher","first-page":"5709","DOI":"10.1113\/JP275429","article-title":"Parturition and the perinatal period: can mode of delivery impact on the future health of the neonate?","volume":"596","author":"Tribe","year":"2018","journal-title":"J Physiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1111\/j.1471-0528.2005.00620.x","article-title":"Stress responses at birth: determinants of cord arterial cortisol and links with cortisol response in infancy","volume":"112","author":"Miller","year":"2005","journal-title":"BJOG."},{"key":"B38","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.ajog.2012.08.024","article-title":"Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery","volume":"207","author":"Schuller","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s00404-019-05213-w","article-title":"Investigation of the impact of birth by cesarean section on fetal and maternal metabolism","volume":"300","author":"Shokry","year":"2019","journal-title":"Arch Gynecol Obstet."},{"key":"B40","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1146\/annurev-nutr-071816-064827","article-title":"Genetic Basis for Sex Differences in Obesity and Lipid Metabolism","volume":"37","author":"Link","year":"2017","journal-title":"Annu Rev Nutr."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.3390\/nu12092735","article-title":"Adipose tissue development and expansion from the womb to adolescence: an overview","volume":"12","author":"Orsso","year":"2020","journal-title":"Nutrients"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e1002709","DOI":"10.1371\/journal.pgen.1002709","article-title":"The number of x chromosomes causes sex differences in adiposity in mice","volume":"8","author":"Chen","year":"2012","journal-title":"PLoS Genet."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1186\/s12889-016-3757-7","article-title":"Identifying developmental trajectories of body mass index in childhood using latent class growth (mixture) modelling: associations with dietary, sedentary and physical activity behaviors: a longitudinal study","volume":"16","author":"Koning","year":"2016","journal-title":"BMC Public Health."},{"key":"B44","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1093\/aje\/kwq389","article-title":"Short sleep duration and body mass index: a prospective longitudinal study in preadolescence","volume":"173","author":"Seegers","year":"2011","journal-title":"Am J Epidemiol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/ijo.2017.178","article-title":"Modifiable risk factors in the first 1000 days for subsequent risk ofchildhood overweight in an Asian cohort: significance of parental overweight status","volume":"42","author":"Aris","year":"2018","journal-title":"Int J Obes (Lond)"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.985851\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T09:29:31Z","timestamp":1663666171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.985851\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,20]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2022.985851"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.985851","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,20]]},"article-number":"985851"}}