Study links C-sections with obesity, stunting in babies

Elective caesarean delivery, many times sought by expectant mothers and their families, may be contributing to excess weight and stunting of babies, public health researchers from India and USA have warned in a new study.

Since it is a major surgery, C-sections are typically performed if there are complications from pregnancy which put the health of the mother or child at risk. But in a clear case of misuse almost all over India, caesarean deliveries are performed way above the WHO (World Health Organisation) recommended limits.

"The risk for being overweight and obese at one year of birth is nearly 130% more for babies born through C-section when compared against infants born through the normal vaginal route,” Giridhar Babu, epidemiologist at the Indian Institute of Public Health, Bengaluru, and lead author of the study, told DH. Also, such babies will have a tendency towards stunting.

Babu and his colleagues from IIPH, Bengaluru and Hyderabad as well as Johns Hopkins Bloomberg School of Public Health in the US analysed 638 pregnancies for the study. They were part of a larger group of 2,900 mothers who are being studied for more than five years to understand any link between overweight and maternal health.

Among the 638 cases, the rate of caesarean delivery was 43.4% of which 26.5% was emergency surgeries and 16.9% was elective.

“Compared to vaginal delivery, elective C-section was associated with higher body mass index. Infants born by elective C-section had higher risk of being overweight but no such association was found for emergency C-section. Also elective C-section delivery was associated with reduced linear growth at one year,” the researchers reported in the journal Pediatric Research on Tuesday.

The finding comes at a time when the National Family Health Survey (NFHS) data reveals widespread and increasing use of C-sections all over the country.

The latest NFHS-5 survey shows C-section is being overused by 18 out of 22 states, with Telangana and Andhra Pradesh topping the list.

Almost 61% deliveries in Telangana are done by C-section followed by 42% in Andhra Pradesh. In Telangana, more than 80% of the deliveries at private hospitals are performed through a C-section. The trend is the same in West Bengal private hospitals too.

In Karnataka, 31.5% of all deliveries are through caesarean routes. The practice rose by 9% from the previous round of NFHS carried out in 2015-16. In private hospitals, more than half of all the deliveries are being done by C-section.

But going by the WHO, the ideal caesarean rate would be 10-15% of all the deliveries. “We need to make people aware of the risks associated with such rampant use of C-section,” Babu said.

While the reason behind such an association is unknown, the commonest hypothesis is that there is a disruption in the transfer of the mother's gut microbiota (colony of beneficial bacteria) to the child, which may be the underlying factor behind the adverse consequences.