Association between Cesarean section and neurodevelopmental disorders in a Japanese birth cohort: the Japan Environment and Children’s Study

Abstract

Background The long-term effects of a Cesarean section (CS) birth on child neurodevelopment are of increasing interest. In this study, we examined the associations between mode of delivery and presence of neurodevelopmental disorders in toddlers. Moreover, given that the prevalence of several neurodevelopmental disorders such as autism spectrum disorder (ASD) is known to differ by sex, we also investigated these associations separately in male and female toddlers. Methods We investigated 65,701 mother–toddler pairs from the Japan Environment and Children’s Study, a nationally representative children’s cohort study. To investigate the associations between mode of delivery (CS or vaginal delivery) and neurodevelopmental disorders (motor delay, intellectual disability, and ASD) in 3-year-old toddlers as a whole and stratified by sex, we used logistic regression models to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results The morbidity of ASD at age 3 years was higher for children delivered by CS than those delivered vaginally (aOR 1.38, 95% CI 1.04–1.83). However, no such difference was evident in the case of motor delay or intellectual disability (aOR 1.33, 95% CI 0.94–1.89; aOR 1.18, 95% CI 0.94–1.49, respectively). In the analysis by sex, CS was not associated with increased risk of any of the neurodevelopmental disorders in males, but it was associated with increased risks of motor delay (aOR 1.88, 95% CI 1.02–3.47) and ASD (aOR 1.82, 95% CI 1.04–3.16) in females. Conclusions This study provides evidence of significant associations between mode of delivery and neurodevelopmental disorders in early childhood. Females may be more sensitive to the effects of CS than males.

Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan

“…While previous studies have suggested an association between cesarean section and neurodevelopmental disorders 27 – 29 , a large Swedish cohort study in 2021 reported no association between cesarean section and abnormal neurological development 30 . This may be, in part, due to the many confounding factors expected to affect the child’s neurological developmental disorders, such as the reason for choosing a cesarean section, whether the cesarean section was an emergency or scheduled, and whether regional or general anesthesia was used.…”