The dual burden of malnutrition increases the risk of cesarean delivery: Evidence from India
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The dual burden of malnutrition increases the risk of cesarean delivery: Evidence from India. / Wells, Jonathan C K; Wibæk Christensen, Rasmus; Poullas, Marios.
I: Frontiers in Public Health, Bind 6, 292, 2018.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - The dual burden of malnutrition increases the risk of cesarean delivery: Evidence from India
AU - Wells, Jonathan C K
AU - Wibæk Christensen, Rasmus
AU - Poullas, Marios
N1 - CURIS 2018 NEXS 367
PY - 2018
Y1 - 2018
N2 - Background: Among contemporary human populations, rates of cesarean delivery vary substantially, making it difficult to know if the procedure is inadequately available, or used excessively relative to medical need. A much-cited evolutionary hypothesis attributed birth complications to an “obstetric dilemma,” resulting from antagonistic selective pressures acting on maternal pelvic dimensions and fetal brain growth during hominin evolution. However, the childbirth challenges experienced by living humans may not be representative of those in the past, and may vary in association with trends in ecological conditions. We hypothesized that variability in maternal phenotype (height and nutritional status) may contribute to the risk of cesarean delivery. In many populations, high levels of child stunting contribute to a high frequency of short adult stature, while obesity is also becoming more common. The combination of short maternal stature and maternal overweight or obesity may substantially increase the risk of cesarean delivery.Methods: Using data from two large Indian health surveys from 2005–6 to 2015–2016, we tested associations of maternal somatic phenotype (short stature, overweight) with the risk of cesarean delivery, adjusting for confounding factors such as maternal age, birth order, rural/urban location, wealth and offspring sex.Results: Secular trends in maternal body mass index between surveys were greater than trends in height. Maternal short stature and overweight both increased the risk of cesarean delivery, most strongly when jointly present within individual women. These associations were independent of birth order, wealth, maternal age and rural/urban location. Secular trends in maternal phenotype explained 18% of the increase in cesarean rate over 10 years.Conclusion: Our results highlight how the emerging dual burden of malnutrition (persisting short adult stature which reflects persistent child stunting; increasing overweight in adults) is likely to impact childbirth in low and middle-income countries.
AB - Background: Among contemporary human populations, rates of cesarean delivery vary substantially, making it difficult to know if the procedure is inadequately available, or used excessively relative to medical need. A much-cited evolutionary hypothesis attributed birth complications to an “obstetric dilemma,” resulting from antagonistic selective pressures acting on maternal pelvic dimensions and fetal brain growth during hominin evolution. However, the childbirth challenges experienced by living humans may not be representative of those in the past, and may vary in association with trends in ecological conditions. We hypothesized that variability in maternal phenotype (height and nutritional status) may contribute to the risk of cesarean delivery. In many populations, high levels of child stunting contribute to a high frequency of short adult stature, while obesity is also becoming more common. The combination of short maternal stature and maternal overweight or obesity may substantially increase the risk of cesarean delivery.Methods: Using data from two large Indian health surveys from 2005–6 to 2015–2016, we tested associations of maternal somatic phenotype (short stature, overweight) with the risk of cesarean delivery, adjusting for confounding factors such as maternal age, birth order, rural/urban location, wealth and offspring sex.Results: Secular trends in maternal body mass index between surveys were greater than trends in height. Maternal short stature and overweight both increased the risk of cesarean delivery, most strongly when jointly present within individual women. These associations were independent of birth order, wealth, maternal age and rural/urban location. Secular trends in maternal phenotype explained 18% of the increase in cesarean rate over 10 years.Conclusion: Our results highlight how the emerging dual burden of malnutrition (persisting short adult stature which reflects persistent child stunting; increasing overweight in adults) is likely to impact childbirth in low and middle-income countries.
KW - India
KW - South Asia
KW - Dual burden of malnutrition
KW - Short stature
KW - Overweight
KW - Obesity
KW - Cesarean deliviery
KW - Obstetric dilemma
U2 - 10.3389/fpubh.2018.00292
DO - 10.3389/fpubh.2018.00292
M3 - Journal article
C2 - 30386761
VL - 6
JO - Frontiers in Public Health
JF - Frontiers in Public Health
SN - 2296-2565
M1 - 292
ER -
ID: 204306333