Arch. Dis. Child：剖腹产或增孩子肥胖风险

现在越来越多的人生孩子选择剖腹产，而新一期英国《小儿疾病文献》（Archives of Disease in Childhood）杂志刊登报告说，通过剖腹产出生的孩子出现肥胖症症状的风险更高，这应该成为准父母们需要考虑的一个问题。

美国波士顿儿童医院等机构研究人员调查了1255对妈妈和宝宝的情况，其中有约四分之一的孩子是通过剖腹产出生。在孩子3岁时的跟踪调查显示，他们出现肥胖症状的风险是其他孩子的约两倍。

研究人员说，这个现象背后可能有两方面原因。一是那些本身偏胖的妈妈选择剖腹产的可能性更高，而母亲的肥胖程度是导致孩子肥胖的因素之一。

另一个可能的原因与生产方式有关，以自然方式生产的孩子在经过产道时会携带上母亲体内的一些细菌，而通过剖腹产出生的孩子则缺少这些细菌。这可能会造成新生儿肠道内菌群的差异，使他们的身体在吸收食物营养时存在某些差别，最终导致肥胖风险的不同。

doi:10.1136/archdischild-2011-301141
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Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study

Susanna Y Huh1, Sheryl L Rifas-Shiman2, Chloe A Zera3, Janet W Rich Edwards4, Emily Oken2, Scott T Weiss5, Matthew W Gillman2,6

Abstract Objective To examine whether delivery by caesarean section is a risk factor for childhood obesity. Design Prospective prebirth cohort study (Project Viva). Setting Eight outpatient multi-specialty practices based in the Boston, Massachusetts area. Participants We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age. Main outcome measures BMI score, obesity (BMI for age and sex ≥95th percentile), and sum of triceps plus subscapular skinfold thicknesses at 3 years of age. Results 284 children (22.6%) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal prepregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95% CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps plus subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51). Conclusions Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.