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

Abstract

Purpose To 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. Methods Similar 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. Results There 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. Conclusions Results of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.

Association between obstetric mode of delivery and emotional and behavioural problems in children and adolescents: the children of the 90s health study

“…Our findings are broadly consistent with few existing studies that have reported no significant association between mode of delivery and child behavioural problems [ 31 – 34 ]. In the UK Millennium cohort study, Curran et al [ 31 ] found no association between modes of delivery and behavioural difficulties (also measured by SDQ) in children aged 7 years.…”

“…This study also used CBCL to measure children internalising problems and did not report findings from the CBCL sub-scales. However, more comparable studies by Maher et al [ 34 ] and Leung et al [ 33 ] found no evidence of associations between assisted vaginal delivery and emotional problems at age 11 when measured by SDQ. Taken together, the overall evidence signals the need for further research, particularly in older children, to confirm the robustness of our findings as well as to better understand the relationship between assisted vaginal delivery and offspring emotional development.…”

“…Existing evidence on the relationship between mode of delivery and offspring emotional and behavioural problems is limited and inconsistent. While some studies reported an increased risk of behavioural difficulties in offspring of mothers who gave birth via CS or assisted vaginal delivery [ 28 – 30 ], others reported no significant association [ 31 – 34 ]. Most of the existing studies examined the association at a one-time point only [ 28 – 32 ], did not distinguish between assisted vaginal delivery and spontaneous vaginal delivery and/or planned and emergency CS [ 28 , 30 , 33 ], did not examine specific emotional and behavioural outcomes (peer relationship behaviours, emotional problems, conduct problems, and hyperactivity/inattention problems) [ 28 , 29 , 31 , 32 ], and have not consistently accounted for confounding factors, such as maternal depressive symptoms during pregnancy, parity, pre-eclampsia and gestational diabetes [ 28 – 30 , 32 ], which are found to be linked to offspring behaviour problems.…”

The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression?

“…Previous research, although limited, identifies emergency C-sections as an influential factor in the development of childhood behavioral problems [3,50]. Emergency C-sections are associated with higher total SDQ and peer problem scores among five-year-old children [50]. The findings of a study performed by Rutayisire, Wu [3] also support this link; however, it identified an association between elective and emergency C-sections and total abnormal SDQ scores among children aged three to six.…”

“…Previous research, although limited, identifies emergency C-sections as an influential factor in the development of childhood behavioral problems [3,50]. Emergency C-sections are associated with higher total SDQ and peer problem scores among five-year-old children [50].…”