Abstract
The aim of this study was to analyse the relationship between the type of delivery (vaginal or caesarean), as a risk factor, and the likelihood of having learning disabilities in reading (reading accuracy) and writing (phonetic and visual orthography), controlling for the interaction and/or confounding effect of gestational, obstetric, and neonatal variables (maternal age at delivery, gestational age, foetal presentation, Apgar 1, and newborn weight) among six-year-old children born in twin births. In this retrospective cohort study, the exposed and non-exposed cohorts consisted of children born by caesarean section and vaginal delivery, respectively. A total of 124 children born in twin births were evaluated in year one of primary education. Intelligence was measured using the K-BIT test; reading and writing variables were evaluated using the Evalúa-1 battery of tests, and clinical records were used to measure gestational, obstetric, and neonatal variables. Binary logistic regressions applied to each dependent variable indicated that caesarean delivery is a possible independent risk factor for difficulties in reading accuracy and phonetic and visual orthography. Future research using larger samples of younger children is required to analyse the relationship between obstetric and neonatal variables and the different basic indicators of reading and writing.
Highlights
Twins have been considered in some studies as a psychologically and academically vulnerable population, even though this population is subject to the influence of certain prenatal and perinatal factors—the interest of this study [1]
In line with the preliminary statistical analysis, only the variable type of delivery was shown as a possible risk factor for disabilities in the reading and writing measures taken into account in this study. The objective of this cohort study of children born in twin births once they reached the age of 6 was to analyse retrospectively the relationship between reading accuracy and phonetic and visual orthography with type of delivery, evaluating the degree to which type of delivery may be related to the risk of having difficulties in these basic and specific components of reading and writing, and controlling statistically for possible interacting and confounding factors
The risk of having difficulties in reading accuracy and phonetic and visual orthography can be around 3 times higher among the children born by caesarean section than those born through vaginal delivery
Summary
Twins have been considered in some studies as a psychologically and academically vulnerable population, even though this population is subject to the influence of certain prenatal and perinatal factors—the interest of this study [1]. Multiple births are associated with prematurity, low Apgar scores, neonatal sepsis, pulmonary hypertension, hyperbilirubinaemia, and restricted intrauterine growth, among others Some of these complications can on occasion lead to neuropsychological difficulties, academic difficulties, and even death [2,3,4,5,6]. Specific learning disabilities in reading and writing present disorders in cognitive processes and associative behaviours, which are explained by hypotheses on the biological origin thereof [7,8,9,10,11,12] Pupils who display such difficulties have below the expected reading and writing level for their age, despite receiving adequate instruction for at least six months and having the intelligence to be a good reader [8,12]. These specific difficulties affect lexical and sub-lexical processes (visual and phonological processing) implicit in both reading and writing accuracy, and they result from a deficit in the phonological component that is neurobiological in origin [7]
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