Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study

Abstract

The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children’s Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes.

Obstetrical mode of delivery and behavioural outcomes in childhood and adolescence: findings from the Millennium Cohort Study

“…Comparable with our findings, no significant association was observed between caesarean section and internalizing (emotional and peer problems) and externalizing (conduct and hyperactivity) domains of the SDQ in a Czech Republic cohort in children of preschool age [31]. However, the authors did not distinguish between planned and emergency caesarean section due to a small sample size (N = 256) [31].…”

Early Environmental and Biological Influences on Preschool Motor Skills: Implications for Early Childhood Care and Education

“…Therefore, in our study, even using a classification that has been previously used in the literature, there was no differentiation made as to whether the vaginal delivery involved the use of instruments or not (for example, the use of forceps, vacuum, and spatulas), or whether the C-section was programmed or due to an emergency. Some authors have indicated that these aspects, not considered in our work, may have distinct effects on children's motor development (Tribe et al, 2018;Takács et al, 2020).…”

“…Therefore, we believe that the detailed and extensive assessment process of preschool motor skills conducted via systematic observation is another strong point of this work. This suggests that the assessment of motor skills was: (1) objective -not subjective as some teachers had admitted to being (Cueto et al, 2017)-and was not based on third party information, as it often occurs in studies (Khalaf et al, 2015;Takács et al, 2020), despite the limitations that this may imply (Blanco-Villaseñor and Escolano-Pérez, 2017); (2) carried out in the child's natural setting, such as at school, capturing the spontaneous motor execution by the children during recreational activities that are significant and of interest to them. This assessment is characterized by a high ecological validity (Blanco-Villaseñor and Escolano-Pérez, 2017), and allows us to overcome the ecological validity issues present in other studies on motor skill assessment (Tamplain et al, 2020); and (3) carried out using an instrument created based on the objective and context of the study.…”

“…The mode of delivery has been directly related to biochemical and structural changes in the central nervous system, although their consequences are not wellknown. Thus far, literature on this area (especially referring to the influence of the delivery mode on motor skills) has been inconclusive, since studies are scarce and they offer conflicting results (Blazkova et al, 2020;Takács et al, 2020).…”

“…Some studies have found no evidence to affirm that children born by C-section display poorer gross and fine motor skills than those born by vaginal delivery (Zhou et al, 2019;Takács et al, 2020).…”