Table 4.
Associations of mode of delivery (unplanned cesarean, planned vs. vaginal delivery) with metabolic health and inflammation biomarkers during mid-childhood (N = 689) and early adolescence (N = 709) in Project Viva.
| N | Model 0 | Model 1 | Model 2 | |
|---|---|---|---|---|
| Mid-childhood outcomes | ||||
| Leptin (ng/mL) | ||||
| Vaginal | 481 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 90 | −11.6 (−26.4, 6.2) | −13.2 (−27.7, 4.1) | −15.9 (−29.8, 0.8) |
| CS planned/no labor | 42 | −6.3 (−28.4, 22.7) | −14.1 (−34.6, 12.8) | −15.0 (−35.2, 11.6) |
| Adiponectin (µg/mL) | ||||
| Vaginal | 481 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 90 | −5.0 (−16.6, 8.2) | −4.9 (−16.5, 8.2) | −5.3 (−16.9, 7.8) |
| CS planned/no labor | 42 | −6.1 (−22.4, 13.6) | −4.6 (−21.4, 15.8) | −5.6 (−22.3, 14.7) |
| Insulin (µU/mL) | ||||
| Vaginal | 474 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 89 | −6.0 (−20.2, 10.7) | −9.1 (−22.8, 7.1) | −10.0 (−23.7, 6.0) |
| CS planned/no labor | 41 | 25.8 (−1.6, 60.8) | 13.4 (−11.7, 45.7) | 13.9 (−11.5, 46.7) |
| Glucose (mg/dL) | ||||
| Vaginal | 450 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 84 | −3.4 (−6.7, 0.0) | −3.2 (−6.5, 0.2) | −3.3 (−6.6, 0.2) |
| CS planned/no labor | 41 | 2.1 (−2.9, 7.3) | 1.5 (−3.5, 6.9) | 1.7 (−3.4, 7.0) |
| HOMA-IR (U) | ||||
| Vaginal | 436 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 80 | −12.4 (−26.8, 4.8) | −13.7 (−27.8, 3.2) | −14.9 (−28.9, 1.9) |
| CS planned/no labor | 39 | 23.5 (−5.1, 60.6) | 11.5 (−14.7, 45.7) | 10.6 (−15.6, 44.9) |
| HDL-C (mg/dL) | ||||
| Vaginal | 493 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 89 | 1.1 (−4.2, 6.7) | 0.8 (−4.5, 6.4) | 0.9 (−4.3, 6.5) |
| CS planned/no labor | 45 | −4.2 (−11.2, 3.4) | −3.4 (−10.6, 4.4) | −2.9 (−10.1, 5.0) |
| Triglycerides (mg/dL) | ||||
| Vaginal | 492 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 89 | 0.1 (−8.7, 9.8) | −0.4 (−9.2, 9.2) | −0.5 (−9.3, 9.2) |
| CS planned/no labor | 45 | −4.2 (−15.9, 9.2) | −4.3 (−16.3, 9.4) | −4.4 (−16.5, 9.4) |
| IL-6 (pg/mL) | ||||
| Vaginal | 481 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 90 | −16.2 (−30.8, 1.5) | −16.3 (−30.8, 1.3) | −15.3 (−30.0, 2.5) |
| CS planned/no labor | 42 | 6.1 (−19.9, 40.6) | −0.9 (−25.5, 31.7) | −4.3 (−28.1, 27.5) |
| CRP (mg/L) | ||||
| Vaginal | 489 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 89 | −0.9 (−31.6, 43.4) | −4.8 (−34.0, 37.2) | −7.5 (−35.8, 33.3) |
| CS planned/no labor | 49 | 50.8 (−9.3,150.6) | 24.1 (−25.6,106.8) | 16.6 (−30.1, 94.5) |
| Metabolic risk z-score | ||||
| Vaginal | 425 | 0.0 (ref.) | 0.0 (ref.) | 0.0 (ref.) |
| CS unplanned/labor | 76 | −0.06 (−0.21, 0.09) | −0.07 (−0.22, 0.08) | −0.10 (−0.25, 0.05) |
| CS planned/no labor | 39 | 0.15 (−0.07, 0.37) | 0.04 (−0.18, 0.26) | 0.02 (−0.20, 0.24) |
| Early adolescent outcomes | ||||
| Leptin (ng/mL) | ||||
| Vaginal | 534 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | 4.9 (−15.4, 30.1) | 1.2 (−17.6, 24.4) | −0.2 (−18.5, 22.3) |
| CS planned/no labor | 49 | 25.6 (−7.4, 70.4) | 19.1 (−11.2, 59.8) | 17.8 (−11.8, 57.5) |
| Adiponectin (µg/mL) | ||||
| Vaginal | 534 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | −13.2 (−21.0, −4.7) | −11.5 (−19.3, −3.0) | −11.5 (−19.3, −2.9) |
| CS planned/no labor | 49 | −10.9 (−22.0, 1.8) | −10.6 (−21.6, 1.9) | −10.7 (−21.7, 1.9) |
| Insulin (µU/mL) | ||||
| Vaginal | 533 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | 13.6 (−0.7, 30.0) | 12.7 (−1.3, 28.6) | 11.9 (−2.0, 27.7) |
| CS planned/no labor | 49 | 8.9 (−10.1, 31.9) | 9.6 (−9.2, 32.5) | 10.2 (−8.8, 33.2) |
| Glucose (mg/dL) | ||||
| Vaginal | 481 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 92 | −0.9 (−3.7, 2.0) | −1.1 (−4.0, 1.8) | −1.2 (−4.0, 1.8) |
| CS planned/no labor | 47 | 0.1 (−3.8, 4.2) | −0.4 (−4.3, 3.7) | −0.1 (−4.1, 4.0) |
| HOMA-IR (U) | ||||
| Vaginal | 465 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 89 | 13.8 (−0.5, 30.3) | 12.7 (−1.0, 28.3) | 11.6 (−1.9, 27.0) |
| CS planned/no labor | 44 | 4.2 (−13.8, 25.9) | 2.5 (−14.5, 22.9) | 2.3 (−14.7, 22.7) |
| HDL-C (mg/dL) | ||||
| Vaginal | 534 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | −2.3 (−7.3, 3.0) | −1.8 (−6.8, 3.5) | −1.5 (−6.5, 3.7) |
| CS planned/no labor | 49 | −4.6 (−11.5, 2.8) | −3.3 (−10.3, 4.2) | −3.0 (−9.9, 4.6) |
| Triglycerides (mg/dL) | ||||
| Vaginal | 534 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | −0.7 (−9.5, 8.9) | −0.4 (−9.2, 9.2) | −0.5 (−9.3, 9.1) |
| CS planned/no labor | 49 | −4.2 (−16.0, 9.3) | −6.7 (−18.2, 6.5) | −6.6 (−18.1, 6.6) |
| IL-6 (pg/mL) | ||||
| Vaginal | 530 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 102 | 4.9 (−9.1, 20.9) | 3.1 (−10.6, 18.9) | 3.1 (−10.7, 18.9) |
| CS planned/no labor | 49 | −12.2 (−28.3, 7.6) | −13.9 (−29.7, 5.5) | −13.6 (−29.5, 6.0) |
| CRP (mg/L) | ||||
| Vaginal | 519 | 1.0 (ref.) | 1.0 (ref.) | 1.0 (ref.) |
| CS unplanned/labor | 98 | 12.7 (−13.1, 46.1) | 6.6 (−17.3, 37.4) | 4.5 (−18.8, 34.5) |
| CS planned/no labor | 47 | 12.3 (−22.6, 63.0) | 2.1 (−29.1, 47.0) | 0.2 (−30.3, 44.1) |
| Metabolic risk z-score | ||||
| Vaginal | 461 | 0.0 (ref.) | 0.0 (ref.) | 0.0 (ref.) |
| CS unplanned/labor | 85 | 0.09 (−0.01, 0.20) | 0.08 (−0.02, 0.19) | 0.08 (−0.03, 0.18) |
| CS planned/no labor | 43 | 0.08 (−0.07, 0.23) | 0.05 (−0.10, 0.20) | 0.04 (−0.10, 0.19) |
Plasma metabolic health and inflammation biomarkers were log-transformed and thus data are presented as % difference (95% CI) [except for metabolic risk z-score, β (95% CI)]. We used stabilized inverse probability weights to account for censoring.
Model 0: adjusted for child age and sex.
Model 1: Model 0 + maternal prepregnancy BMI, age, education, and race/ethnicity.
Model 2: Model 1 + total GWG, pregnancy smoking, BW/GA z-score, and father’s BMI.
CRP C-reactive protein, HDL-C high-density lipoprotein, HOMA-IR homeostatic model assessment of insulin resistance, IL-6 interleukin-6.