Abstract
The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and “mood disorder” construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.
Highlights
Birth by cesarean section is a life-saving surgical procedure in cases with maternal-fetal complications
The authors found an increased risk of bipolar disorder in individuals born by elective cesarean section in the adjusted model; the statistical data analysis with paired-to-sibling Cox regression model no longer indicated a significant association
Studies have addressed the association between cesarean birth and the development of mood disorders, such as depression and bipolar disorder, which are conditions with complex etiology yet to be completely understood [13,14,19,33]
Summary
Birth by cesarean section is a life-saving surgical procedure in cases with maternal-fetal complications. Studies have shown that cesarean birth is associated with alterations in the child’s intestinal bacterial microbiome, loss of benefits resulting from exposure to deliveryinduced hormonal and immunological physiological changes, and neurodevelopmental disorders [3,4,5,6]. These complications could explain the increased risk of obesity [7,8], allergic and respiratory diseases [9], and Type 1 diabetes mellitus [10] in children delivered by cesarean section. The literature has indicated a higher risk of autism spectrum disorder, attention deficit and hyperactivity disorder [11,12], and bipolar mood disorder in individuals delivered by cesarean procedures [13,14]
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Schedule a callMore From: Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
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