Abstract
PurposeTo examine the association between mode of delivery (in particular caesarean section) and behavioural outcomes in offspring at six time-points between age 3 and 17 years.MethodsSimilar to previous work examining the association between mode of delivery and behavioural outcomes in offspring at age 7, we used maternal-reported data from the Millennium Cohort Study. Data on mode of delivery were collected when children were 9 months and categorised as spontaneous vaginal delivery, assisted vaginal delivery, induced vaginal delivery, emergency caesarean section, planned caesarean section and caesarean section after induction of labor. Data on behavioural outcomes were collected at ages 3, 5, 7, 11, 14 and 17 years using the Strengths and Difficulties Questionnaire (SDQ). Crude and adjusted logistic regression examined mode of delivery–behavioural difficulties relationship, using validated SDQ cut-off points (total SDQ ≥ 17, emotional ≥ 5, conduct ≥ 4, hyperactivity ≥ 7, peer problems ≥ 4 and prosocial behaviour ≤ 4). Multilevel models with linear splines examined the association between mode of delivery and repeated measures of SDQ.ResultsThere were 18,213 singleton mother–child pairs included at baseline, 13,600 at age 3; 13,831 at age 5; 12,687 at age 7; 11,055 at age 11; 10,745 at age 14 and 8839 at age 17. Adjusted logistic regression suggested few associations between mode of delivery and behavioural outcomes at ages 3, 5, 11, 14 and 17 years using validated SDQ cut-off points. After correction for multiple testing, only the protective association between planned caesarean section-Conduct difficulties at age 5 years (OR 0.63, 95% CI 0.46, 0.85) and positive association between caesarean section after induction-Emotional difficulties at age 11 years (OR 1.57, 95% CI 1.19, 2.07) remained statistically significant. Multilevel modelling suggested mean SDQ scores were similar in each mode of delivery group at each time point.ConclusionsResults of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.
Highlights
Previous studies suggest a small increase in the likelihood of attention deficit hyperactivity disorder [7], autism spectrum disorder [8], and adverse behavioural outcomes [9] in children delivered via caesarean section, with the concept of a microbiota–gut–brain axis often cited as the mechanism linking caesarean section to neurodevelopment [10]
Spontaneous vaginal delivery was reported in 48.68% (n = 8866) participants, assisted vaginal delivery in 9.53% (n = 1735), induced vaginal delivery in 20.52% (n = 3739), emergency caesarean section in 6.88% (n = 1253), planned caesarean section in 7.91% (n = 1440), and caesarean section after induction in 6.48% (n = 1180) participants
Logistic regression: Adjusted results in Table 2 suggested that planned caesarean section was associated with a 33% reduction in odds of having Prosocial Behaviour difficulties at age 3 years compared to spontaneous vaginal delivery
Summary
Between 2000 and 2015, birth by caesarean section has increased from ~12 to ~21% globally but with considerable variations between countries driven by factors such as income level of Ireland 3 Department of Obstetrics and Gynaecology, University. This study showed an effect among those born via induced vaginal delivery, though results attenuated after controlling for several important confounders [18]. Further research on this cohort, allowing for changes in behaviour over time, is warranted to inform pregnant women, their partners and clinicians of the potential effects of caesarean section on behavioural outcomes in the offspring
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