Laura Moreno-Galarraga1,2,3, Andrea Romanos Nanclares2,3, Lorena García-Blanco2,4, Cristina Esteve Cornejo5, Borja Domingo Cardenal6, Miguel A Martínez-González2,3,7,8, Nerea Martín-Calvo2,3,7. 1. Department of Pediatrics, Navarra Hospital Complex, Navarra Heath Service, Pamplona, Spain. 2. IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra Institute for Health Research, Pamplona, Spain. 3. Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain. 4. San Juan Primary Health Center, Navarra Heath Service, Pamplona, Spain. 5. Department of Pediatrics, University of Navarra Clinic, Madrid, Spain. 6. School of Medecine, University of Navarra, Pamplona, Spain. 7. Center for Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain. 8. Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Abstract
AIM: The association between caesarean delivery and the risk of overweight/obesity in the offspring has been previously reported using conventional measures of association (relative risks or odds ratios). We aimed at refining the existing evidence by calculating the marginal effect of the exposure and estimating the unmeasured residual confounding. METHODS: In the 'SEguimiento del Niño para un Desarrollo Óptimo' Project, a dynamic multipurpose paediatric cohort study, we collected information from parents through self-administered online questionnaires. We estimated the offspring's risk of overweight/obesity at age 4-6 years, associated with the type of delivery through marginal effect of the exposure. Unmeasured residual confounding was assessed using the E-value. RESULTS: Among 407 participants (mean-age: 5.0 years (standard deviation: 0.9)), 86 (21.1%) were born by caesarean delivery. Children born by caesarean delivery had higher odds of overweight/obesity than those born vaginally. Subgroup analyses showed similar results. The multivariable adjusted marginal effect showed that caesarean delivery was associated with an 8.0% (95% confidence interval: 0.2-15.7) absolute increase in the prevalence of overweight/obesity. The estimated residual confounding showed an E-value of 4.03, higher than the OR obtained for all the confounding factors we accounted for. CONCLUSIONS: Caesarean delivery was associated with an 8% absolute increase in the risk of overweight/obesity that is very unlikely explained by residual confounding.
AIM: The association between caesarean delivery and the risk of overweight/obesity in the offspring has been previously reported using conventional measures of association (relative risks or odds ratios). We aimed at refining the existing evidence by calculating the marginal effect of the exposure and estimating the unmeasured residual confounding. METHODS: In the 'SEguimiento del Niño para un Desarrollo Óptimo' Project, a dynamic multipurpose paediatric cohort study, we collected information from parents through self-administered online questionnaires. We estimated the offspring's risk of overweight/obesity at age 4-6 years, associated with the type of delivery through marginal effect of the exposure. Unmeasured residual confounding was assessed using the E-value. RESULTS: Among 407 participants (mean-age: 5.0 years (standard deviation: 0.9)), 86 (21.1%) were born by caesarean delivery. Children born by caesarean delivery had higher odds of overweight/obesity than those born vaginally. Subgroup analyses showed similar results. The multivariable adjusted marginal effect showed that caesarean delivery was associated with an 8.0% (95% confidence interval: 0.2-15.7) absolute increase in the prevalence of overweight/obesity. The estimated residual confounding showed an E-value of 4.03, higher than the OR obtained for all the confounding factors we accounted for. CONCLUSIONS: Caesarean delivery was associated with an 8% absolute increase in the risk of overweight/obesity that is very unlikely explained by residual confounding.
Authors: Elizabeth T Jensen; Alain G Bertoni; Osa L Crago; Jerome I Rotter; Yii-Der I Chen; Alexis Wood; Stephen S Rich; Mark O Goodarzi Journal: J Endocr Soc Date: 2022-05-04