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首页 » 华人研究 » JAMA Pediatr:经过剖腹产产下的儿童有更高的风险患上肥胖

JAMA Pediatr:经过剖腹产产下的儿童有更高的风险患上肥胖

来源:生物谷 2016-09-08 22:48


2016年9月8日/生物谷BIOON/--在一项新的研究中,来自美国哈佛陈曾熙公共卫生学院和哈佛医学院等机构的研究人员发现经过剖腹产产下的儿童要比它们的经过阴道分娩产下的兄弟姐妹,可能有更高的风险患上肥胖。这一发现可能对美国每年经过剖腹产产下的将近130万新生儿产生重大的影响。相关研究结果于2016年9月6日在线发表在JAMA Pediatrics期刊上,论文标题为“Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood”。

经过剖腹产产下的儿童的最为常见的风险是呼吸道问题,同时也有越来越多的证据提示着这些儿童当长大成人时也有增加的风险产生其他不良的健康结果。

在这项研究中,研究人员旨在通过研究“今天成长学习(Growing Up Today Study, GUTS)” 活动的参与者来鉴定剖腹产是否与儿童和年轻人肥胖相关联,其中GUTS是通过调差问卷追踪一大群人从儿童到年轻人期间影响肥胖的因素。

这项研究选择的参与者包括15,271名女性产下的22,068个儿童。在这些儿童当中,总共有4921人(占22.3%)是经过剖腹产产下的。

研究结果表明接受过剖腹产的女性在怀孕前有更高的BMI指数,而且更容易患上妊娠糖尿病、子痫前期和妊娠高血压综合征。

根据这些研究结果,相比于经过阴道分娩产下的儿童,经过剖腹产产下的儿童患上肥胖的风险增加了15%。此外,经过剖腹产产下的儿童要比它们的经过阴道分娩产下的兄弟姐妹患上肥胖的可能性增加了64%。

论文通信作者Jorge E. Chavarro博士和同事们也发现在这项研究中,相比于妈妈之前接受过多次剖腹产的儿童,经过阴道分娩产下的儿童患上肥胖的风险下降了31%。

肥胖风险可能与肠道菌群相关联

研究人员猜测观察到的较高的肥胖风险可能是出生时建立的胃肠道菌群差异所导致的。相比于经过剖腹产产下的儿童,经过阴道分娩产下的儿童可能更多地接触到它们的妈妈的胃肠道菌群。而经过剖腹产产下的儿童仅接触到它们的妈妈的皮肤菌群和出生时的外部环境细菌。

其他的研究已证实分娩方法在改变婴儿的肠道菌群组成中发挥着显著性的影响。

经发现,经过剖腹产产下的儿童具有更多的导致感染的葡萄球菌和更少的可能恢复肠道中“好细菌”的双歧杆菌。在肠道菌群定植中,这些儿童也表现出更少多样性的细菌物种,而这与随后的生活中有更高的风险产生体重过重和肥胖相关联。

研究人员说,“我们观察到剖腹产与后代增加的肥胖风险相关联,其中这种风险在青年时期会持续存在。”

研究人员说,“就我们所知,我们也首次报道在剖腹产后的阴道分娩对后代的肥胖产生的保护效应与在出生方式不一样的兄弟姐妹之间的肥胖风险存在的显著性差异是不一致的。”

研究人员还补充道,“这些发现提示着这种关联性可能是剖腹产的真正的不良后果:当在缺乏明显的医学或分娩指征的情形下考虑采用剖腹产时,临床医生和病人应当好好地斟酌一下。”

研究人员注意到尽管大型的针对剖腹产和阴道分娩的随机临床试验可能在伦理上是不可行的,但是针对大型的具有关于孕前、怀孕和分娩的高质量数据的前瞻性研究进一步开展研究还是需要的。

这些数据可能能够让研究人员研究增加的肥胖发生率是否转化为经过剖腹产产下的个人有更高的风险产生不良的心脏代谢结果,如2型糖尿病,高血压,或心血管疾病。(生物谷 Bioon.com)

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Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood

Changzheng Yuan; Audrey J. Gaskins, ScD1,2; Arianna I. Blaine, ScM3; Cuilin Zhang, MD, PhD4; Matthew W. Gillman, MD, SM1,5; Stacey A. Missmer; Alison E. Field, ScD9; Jorge E. Chavarro

doi:10.1001/jamapediatrics.2016.2385
PMC:
PMID:

Importance Cesarean birth has been associated with higher risk of obesity in offspring, but previous studies have focused primarily on childhood obesity and have been hampered by limited control for confounders.

Objective To investigate the association between cesarean birth and risk of obesity in offspring.

Design, Setting, and Participants A prospective cohort study was conducted from September 1, 1996, to December 31, 2012, among participants of the Growing Up Today Study, including 22 068 offspring born to 15 271 women, followed up via questionnaire from ages 9 to 14 through ages 20 to 28 years. Data analysis was conducted from October 10, 2015, to June 14, 2016.

Exposure Birth by cesarean delivery.

Main Outcomes and Measures Risk of obesity based on International Obesity Task Force or World Health Organization body mass index cutoffs, depending on age. Secondary outcomes included risks of obesity associated with changes in mode of delivery and differences in risk between siblings whose modes of birth were discordant.

Results Of the 22 068 offspring (20 950 white; 9359 male and 12 709 female), 4921 individuals (22.3%) were born by cesarean delivery. The cumulative risk of obesity through the end of follow-up was 13% among all participants. The adjusted risk ratio for obesity among offspring delivered via cesarean birth vs those delivered via vaginal birth was 1.15 (95% CI, 1.06-1.26; P = .002). This association was stronger among women without known indications for cesarean delivery (adjusted risk ratio, 1.30; 95% CI, 1.09-1.54; P = .004). Offspring delivered via vaginal birth among women who had undergone a previous cesarean delivery had a 31% (95% CI, 17%-47%) lower risk of obesity compared with those born to women with repeated cesarean deliveries. In within-family analysis, individuals born by cesarean delivery had 64% (8%-148%) higher odds of obesity than did their siblings born via vaginal delivery.

Conclusions and Relevance Cesarean birth was associated with offspring obesity after accounting for major confounding factors. Although additional research is needed to clarify the mechanisms underlying this association, clinicians and patients should weigh this risk when considering cesarean delivery in the absence of a clear indication.
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