14 ms·

Association Between Cesarean Birth and Risk of Obesity

33 points by Mz 10y ago

RA_Fisher 10y ago
It's so disappointing to see studies like these relied on when reported by news outlets. To start, we don't have the data or statistical code used to generate the results. Consider this a basic unit test. Of course we'd want to further scrutinize the code and methodology, but we're not even there. :-( I'd suggest a marker for quantitative research posted to HN along the lines of: runnable?
- porejide 10y ago
  Code: totally agreed. Data: tricky, because of privacy and HIPPA.
- basseq 10y ago
  You could make this complaint about pretty much every academic study ever. Rarely is the underlying data, statistical models, etc. shared publicly. Should they be (for repeatability and peer review)? Sure, I buy that argument. But it's not a valid reason to criticize this particular study. And at least it's the source journal article, not a media post!
  - RA_Fisher 10y ago
    I do make this argument for pretty much every quantitative study.
AWildDHHAppears 10y ago
Why would a person who had had a "Cesarean Birth" choose to eat more? This raises more questions than it answers.
- dragonwriter 10y ago
  > Why would a person who had had a "Cesarean Birth" choose to eat more? The described relation isn't between Cesarean Birth and choosing to eat more.
- asksol 10y ago
  Definitely questionable, but maybe it's related to germs transferred during birth: http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacteria-transfer-could-change-health-for-life-study-shows/ http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacte...
- phormula 10y ago
  It's speculated that cesarian births do not get exposure the the mother's vaginal flora and their microbiome does not get properly seeded. I wonder if manually exposing the child to the mother's flora would be of any benefit.
  - flurie 10y ago
    A pilot study on this was published pretty recently with some success in terms of passing the mother's microbiome on to the infant, though that's still a long way off from determining the benefits. http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html
    - downeveryroad 10y ago
      Thanks for sharing this. Our firstborn was an unscheduled c-section and my wife is now pregnant with our second child. We will likely schedule a c-section this time and I want to do whatever I can to help create a healthy gut microbiome at birth.
  - firstworldman 10y ago
    Before my son was born, we tried to persuade our OB to allow us to do this, or at least to look at the research herself. She wouldn't budge. As an aside, my son was born 12 lb 1 oz, he now weighs 31 lbs at 5 months. The same weight as my 3 1/2 year old daughter.
    - jessaustin 10y ago
      How was it possible to forbid this procedure? Couldn't the mother (perhaps with some help from you?) just do it herself?
    - gohrt 10y ago
      (31-12)3500/ (530) = 440 calories per day, or 18 oz of baby formula per day. That's approximately 100% efficiency converting dietary calories into body mass, or massive water retention. You could cure starvation across the world if you good identify the source of that.
seizethecheese 10y ago
Wild speculation: perhaps those that chose c-section are on average less able to tolerate pain, and therefore lacking in self control (to a degree) and therefore their progeny have a higher likelihood of overeating.
- tonfa 10y ago
  If you read the article, the study was done in context of other studies showing that most of the gut bacteria comes from vaginal birth, e.g http://www.mdpi.com/2076-0817/3/3/769/htm http://www.mdpi.com/2076-0817/3/3/769/htm Correlation between healthy gut bacteria and lower obesity rate are not that surprising.
  - gohrt 10y ago
    That's a tautology -- what does "healthy" mean?
- basseq 10y ago
  Disclaimer: There's a really bad stigma about c-sections and mothers who have them being "less" or "worse" because of it. I'm careful to point this out before we dive into a discussion on making accusations of "poor self-control". That said... If you remove those c-sections that are medically necessary or recommended ("known indicators for cesarean delivery" is the language used in the abstract), then you're left with that population that truly "chose" to have a c-section. The association is stronger in this population. I'd want to tie this back to those demographics. What kind of people truly choose a c-section? Is there something about that demographic that correlates to obesity for other reasons? Are obese women more likely to be counseled towards c-sections? Again, why? It's unclear if they normalized for this. Incidentally, I think your speculation is probably wrong. You assume that c-sections are (or are regarded as) the lower-pain option. You can have a painless "natural" birth with an epidural, and post-birth recovery is going to be "painful"--in different ways--with either path. In other words, don't think people choose c-section for pain management in the first place, which invalidates the rest of your logic chain.
  - 10y ago
ginko 10y ago
Couldn't it be the other way round? Children that tend to obesity are more likely to require a cesarean section? One common reason to use a cesarean is with unusually large babies, for instance.
- te 10y ago
  Yes. The paper's abstract only notes an 'association', not a causal arrow. Readers simply infer the causal arrow.
- midnitewarrior 10y ago
  Cesarean birth in the US is something mothers push for because they don't want the cosmetic consequences of a natural birth. I think technically they need a medical reason for it, but I'm guessing it's not too tough to qualify for it. I have a guess here, in that children who don't travel down the birth canal aren't inoculated with certain bacteria from the mother that may be important in digestive and possible immune function. Just a guess assuming causation, but the mother's birth canal bacteria may play a role in child development.
  - GFischer 10y ago
    Doctors also push for it because they get paid more (according to Freakonomics). A source: http://www.wired.com/2005/05/realestate/ http://www.wired.com/2005/05/realestate/ "consider these findings of a 1996 medical study: Obstetricians in areas with declining birthrates are much more likely to perform cesarean section deliveries than obstetricians in growing areas – suggesting that when business is tough, doctors may try to ring up more expensive procedures."
  - randomdrake 10y ago
    This is so factually incorrect and full of opinion that I felt no choice but to downvote. No, mothers don't just push it because they are concerned about cosmetics. What an overreaching and insulting generalization.
    - midnitewarrior 10y ago
xherberta 10y ago
1) Cesarean birth is a risk factor for developing a less-than-optimal microbiome. (http://jn.nutrition.org/content/138/9/1796S.full http://jn.nutrition.org/content/138/9/1796S.full) 2) Prevalence of certain species in the microbiome is highly correlated with obesity. (http://go.nature.com/1sksCA6 http://go.nature.com/1sksCA6) "Our results indicate that the obese microbiome has an increased capacity to harvest energy from the diet."
- gohrt 10y ago
  Those two facts seem to stand in opposition, unless "optimal" is used in a tautological sense.
Splendor 10y ago
What options currently exist to improve a person's microbiome?
- Mz 10y ago
  Yogurt, probiotic supplements, dietary changes.

33 points by Mz 10y ago

It's so disappointing to see studies like these relied on when reported by news outlets. To start, we don't have the data or statistical code used to generate the results. Consider this a basic unit test. Of course we'd want to further scrutinize the code and methodology, but we're not even there. :-( I'd suggest a marker for quantitative research posted to HN along the lines of: runnable?

porejide 10y ago
Code: totally agreed. Data: tricky, because of privacy and HIPPA.
basseq 10y ago
You could make this complaint about pretty much every academic study ever. Rarely is the underlying data, statistical models, etc. shared publicly. Should they be (for repeatability and peer review)? Sure, I buy that argument. But it's not a valid reason to criticize this particular study. And at least it's the source journal article, not a media post!
- RA_Fisher 10y ago
  I do make this argument for pretty much every quantitative study.

AWildDHHAppears 10y ago

Why would a person who had had a "Cesarean Birth" choose to eat more? This raises more questions than it answers.

dragonwriter 10y ago
> Why would a person who had had a "Cesarean Birth" choose to eat more? The described relation isn't between Cesarean Birth and choosing to eat more.
asksol 10y ago
Definitely questionable, but maybe it's related to germs transferred during birth: http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacteria-transfer-could-change-health-for-life-study-shows/ http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacte...
phormula 10y ago
It's speculated that cesarian births do not get exposure the the mother's vaginal flora and their microbiome does not get properly seeded. I wonder if manually exposing the child to the mother's flora would be of any benefit.
- flurie 10y ago
  A pilot study on this was published pretty recently with some success in terms of passing the mother's microbiome on to the infant, though that's still a long way off from determining the benefits. http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html
  - downeveryroad 10y ago
    Thanks for sharing this. Our firstborn was an unscheduled c-section and my wife is now pregnant with our second child. We will likely schedule a c-section this time and I want to do whatever I can to help create a healthy gut microbiome at birth.
- firstworldman 10y ago
  Before my son was born, we tried to persuade our OB to allow us to do this, or at least to look at the research herself. She wouldn't budge. As an aside, my son was born 12 lb 1 oz, he now weighs 31 lbs at 5 months. The same weight as my 3 1/2 year old daughter.
  - jessaustin 10y ago
    How was it possible to forbid this procedure? Couldn't the mother (perhaps with some help from you?) just do it herself?
  - gohrt 10y ago
    (31-12)3500/ (530) = 440 calories per day, or 18 oz of baby formula per day. That's approximately 100% efficiency converting dietary calories into body mass, or massive water retention. You could cure starvation across the world if you good identify the source of that.

seizethecheese 10y ago

Wild speculation: perhaps those that chose c-section are on average less able to tolerate pain, and therefore lacking in self control (to a degree) and therefore their progeny have a higher likelihood of overeating.

tonfa 10y ago
If you read the article, the study was done in context of other studies showing that most of the gut bacteria comes from vaginal birth, e.g http://www.mdpi.com/2076-0817/3/3/769/htm http://www.mdpi.com/2076-0817/3/3/769/htm Correlation between healthy gut bacteria and lower obesity rate are not that surprising.
- gohrt 10y ago
  That's a tautology -- what does "healthy" mean?
basseq 10y ago
Disclaimer: There's a really bad stigma about c-sections and mothers who have them being "less" or "worse" because of it. I'm careful to point this out before we dive into a discussion on making accusations of "poor self-control". That said... If you remove those c-sections that are medically necessary or recommended ("known indicators for cesarean delivery" is the language used in the abstract), then you're left with that population that truly "chose" to have a c-section. The association is stronger in this population. I'd want to tie this back to those demographics. What kind of people truly choose a c-section? Is there something about that demographic that correlates to obesity for other reasons? Are obese women more likely to be counseled towards c-sections? Again, why? It's unclear if they normalized for this. Incidentally, I think your speculation is probably wrong. You assume that c-sections are (or are regarded as) the lower-pain option. You can have a painless "natural" birth with an epidural, and post-birth recovery is going to be "painful"--in different ways--with either path. In other words, don't think people choose c-section for pain management in the first place, which invalidates the rest of your logic chain.
- 10y ago

ginko 10y ago

Couldn't it be the other way round? Children that tend to obesity are more likely to require a cesarean section? One common reason to use a cesarean is with unusually large babies, for instance.

te 10y ago
Yes. The paper's abstract only notes an 'association', not a causal arrow. Readers simply infer the causal arrow.
midnitewarrior 10y ago
Cesarean birth in the US is something mothers push for because they don't want the cosmetic consequences of a natural birth. I think technically they need a medical reason for it, but I'm guessing it's not too tough to qualify for it. I have a guess here, in that children who don't travel down the birth canal aren't inoculated with certain bacteria from the mother that may be important in digestive and possible immune function. Just a guess assuming causation, but the mother's birth canal bacteria may play a role in child development.
- GFischer 10y ago
  Doctors also push for it because they get paid more (according to Freakonomics). A source: http://www.wired.com/2005/05/realestate/ http://www.wired.com/2005/05/realestate/ "consider these findings of a 1996 medical study: Obstetricians in areas with declining birthrates are much more likely to perform cesarean section deliveries than obstetricians in growing areas – suggesting that when business is tough, doctors may try to ring up more expensive procedures."
- randomdrake 10y ago
  This is so factually incorrect and full of opinion that I felt no choice but to downvote. No, mothers don't just push it because they are concerned about cosmetics. What an overreaching and insulting generalization.
  - midnitewarrior 10y ago

xherberta 10y ago

1) Cesarean birth is a risk factor for developing a less-than-optimal microbiome. (http://jn.nutrition.org/content/138/9/1796S.full http://jn.nutrition.org/content/138/9/1796S.full) 2) Prevalence of certain species in the microbiome is highly correlated with obesity. (http://go.nature.com/1sksCA6 http://go.nature.com/1sksCA6) "Our results indicate that the obese microbiome has an increased capacity to harvest energy from the diet."

gohrt 10y ago
Those two facts seem to stand in opposition, unless "optimal" is used in a tautological sense.

Splendor 10y ago

What options currently exist to improve a person's microbiome?

Mz 10y ago
Yogurt, probiotic supplements, dietary changes.