Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder

Axelsson, Paul; Clausen, Tine D.; Petersen, Anne; Hageman, Ida; Pinborg, Anja; Kessing, Lars Vedel; Bergholt, Thomas; Rasmussen, Steen; Keiding, Niels; Løkkegaard, Ellen

doi:10.1111/jcpp.12961

Cited by 43 publications

(43 citation statements)

References 19 publications

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“…We decided to concentrate on the more recent papers, that used a large sample size and a precise methodology by differentiating between elective and emergency csections. These studies show that not every c-section increases the risk of developing ADHD but only those that were done intrapartum [129,130]. Although this correlation is most probably not due to a differing microbial composition and rather due to various confounders such as gestational age and birth weight [130], it is still important to note that emergency c-sections bear an intrinsic risk for the the offspring developing ADHD.…”

Section: Discussionmentioning

confidence: 95%

“…The reasons for finding a positive correlation between intrapartum c-sections and ADHD development cannot be explained unequivocally as multiple confounders such as unobserved familial factors, birth weight or gestational age also directly influence the mode of delivery and ADHD. However, there is a strong indication that the microbiota plays a subordinate role in this correlation as Axelsson et al discovered that exposure of the newborn to ruptured vs. non-ruptured membranes prior to c-section did not influence the correlation between c-section and ADHD development [130].…”

Section: Obstetric Mode Of Delivery: Vaginal Birth Vs Caesarean Sectmentioning

confidence: 99%

“…Statistical significance (p) [124] No differentiation Altered dopamine response -- [126] No differentiation No effect 248 p = 0.005 [127] No differentiation No effect 12'991 p = 0.05 [128] No differentiation Positive correlation to ADHD -- [129] Elective vs. intrapartum Only intrapartum csection showed a positive correlation to ADHD 1'722'548 p = 0.05 [130] Elective vs. intrapartum Only intrapartum csections showed a positive correlation to ADHD 671'592 p = 0.05…”

Section: Study Type Of C-section Effect Sample Size (N)mentioning

confidence: 99%

“…Results concerning the correlation of early antibiotic use and later risk of developing ADHD seem to be incoherent. A Danish population-based cohort study did not find an association in siblingstratified Cox model between antibiotic use in the first two years of life and the risk of developing ADHD [130]. Another study, however, using 871 European newborns examined the effects of early antibiotic treatment on cognitive functions with the help of IQ and reading tests, and on symptoms of ADHD using the mentioned Conners Rating Scale-Revised (CRS-R).…”

Section: Antibioticsmentioning

confidence: 99%

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The Potential Influence of the Microbiome on the Development and Progression of ADHD

Bull-Larsen¹,

Mohajeri²

2019

Preprint

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The latest research cumulates staggering information about the correlation between the microbiota-gut-brain axis and neurodevelopmental disorders. This review aims to shed light on the potential influence of the microbiome on the development of the most prevalent neurodevelopmental disease, attention-deficit-hyperactive disorder (ADHD). As the etiology and pathophysiology of ADHD are still unclear, finding viable biomarkers and effective treatment still represent a challenge. Therefore, we focused on factors that have been associated with a higher risk of developing ADHD while simultaneously influencing the microbial composition. We reviewed the effect of a differing microbial composition on neurotransmitter concentrations important in the pathophysiology of ADHD. Additionally, we deduced factors that correlate with a high prevalence of ADHD while simultaneously affecting the gut microbiome such as emergency c-sections, and premature birth as the former leads to a decrease of the gut microbial diversity and the latter causes neuroprotective Lactobacillus levels to be reduced. Also, we assessed nutritional influences such as breastfeeding, ingestion of short-chain fatty acids (SCFAs) and polyunsaturated fatty acids (PUFAs) on the host's microbiome and development of ADHD. Finally, we discussed the potential significance of Bifidobacterium as a biomarker for ADHD, the importance of preventing premature birth as prophylaxis and nutrition as a prospective therapeutic measurement against ADHD.

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Section: Discussionmentioning

confidence: 95%

Section: Obstetric Mode Of Delivery: Vaginal Birth Vs Caesarean Sectmentioning

confidence: 99%

Section: Study Type Of C-section Effect Sample Size (N)mentioning

confidence: 99%

Section: Antibioticsmentioning

confidence: 99%

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The Potential Influence of the Microbiome on the Development and Progression of ADHD

Bull-Larsen¹,

Mohajeri²

2019

Preprint

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“…Consequently, new methods addressing feedback (through following data over time) and visualizing complexity while also ensuring timeliness are preferred in the analysis of survival data for QI. Lexis diagrams is one such possible method, used to identify joint effects of age, period, and cohorts [22][23][24], and serve as a possible complement to subsequent statistical survival analysis [25,26]. In its basic configuration, a Lexis diagram visualizes individual lifelines along two time axes: calendar time and age or year since diagnosis [27][28][29], where the lines extends in a 45-degree angle as time passes along both x and y axes.…”

Section: Introductionmentioning

confidence: 99%

Exploring the usefulness of Lexis diagrams for quality improvement

Dahlin

2020

BMC Med Inform Decis Mak

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Background: Visualization is important to aid practitioners in understanding local care processes and drive quality improvement (QI). Important aspects include timely feedback and ability to plot data over time. Moreover, the complexity of care also needs to be understood, as it affects the variation of care processes. However, there is a lack of QI methods visualizing multiple, related factors such as diagnosis date, death date, and cause of death to unravel their complexity, which is necessary to understand processes related to survival data. Lexis diagrams visualize individual patient processes as lines and mark additional factors such as key events. This study explores the potential of Lexis diagrams to support QI through survival data analysis, focusing on feedback, timeliness, and complexity, in a gynecological cancer setting in Sweden. Methods: Lexis diagrams were produced based on data from a gynecological cancer quality registry (4481 patients). The usefulness of Lexis diagrams was explored through iterative data identification and analysis through semi-structured dialogues between the researcher and domain experts (clinically active care process owners) during five meetings. Visualizations were produced and adapted by the researcher between meetings, based on the dialogues, to ensure clinical relevance, resulting in three relevant types of visualizations. Results: Domain experts identified different uses depending on diagnosis group and data visualization. Key results include timely feedback through close-to-real-time visualizations, supporting discussion and understanding of trends and hypothesis-building. Visualization of care process complexity facilitated evaluation of given care. Combined visualization of individual and population levels increased patient focus and may possibly also function to motivate practitioners and management. Conclusion: Lexis diagrams can aid understanding of survival data, triggering important dialogues between care givers and supporting care quality improvement and new perspectives, and can therefore complement survival curves in quality improvement.

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Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring

et al. 2019

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Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder

Cited by 43 publications

References 19 publications

The Potential Influence of the Microbiome on the Development and Progression of ADHD

The Potential Influence of the Microbiome on the Development and Progression of ADHD

Exploring the usefulness of Lexis diagrams for quality improvement

Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring

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