| Summary: | A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Science in Epidemiology and Biostatistics, February 2018 === Background Obesity is an important public health problem and rates have reached epidemic proportions in many countries. South Africa has one of the highest rates of obesity in Africa, with about 38% of the population (and about 44% of adults) estimated to be overweight or obese in 2013. Caesarean section (CS) as a mode of child delivery has been reported to be associated with a low bacterial richness that predisposes infants to being overweight or obese; this early life deprivation is presumed to persist to adulthood. The aim of this study was to determine if mode of delivery is a predictor of early adulthood overweight or obesity. Methods This was a retrospective analysis of data that was collected from a prospective cohort study (Birth to Twenty Plus) established in 1990. A total of 889 young adults aged 21-24 years were included in the analysis. Pearson’s chi-square and Kruskal-Wallis tests were used to assess associations between covariates and BMI categories, and prevalence of overweight or obesity among young adults, across mode of delivery categories. Multiple logistic regression models were fitted to examine the association between mode of delivery and early adulthood overweight or obesity. Results Of the 889 participants, 793 (89.2%) were delivered vaginally, 24 (2.7%) were delivered by assisted VD, and 72 (8.1%) were delivered through CS. The numbers of overweight and obese young adults were 175 (19.7%) and 106 (11.9%), respectively. Caesarean section was significantly associated with obesity in young adults, after adjusting for potential confounders (OR 1.99, 95% CI 1.00–3.94, p=0.049). However, no significant association was observed for overweight + obese combined. Conclusion Caesarean section was statistically associated with early adulthood obesity but not overweight + obesity combined. Mothers and physicians should, however, reduce the use of CS as a delivery procedure unless entirely required. This is due to the higher odds of obesity in later life, the potential biological link between CS and obesity, and the statistically significant associations reported. === XL2018
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