The relation between cesarean birth and child cognitive development

Abstract

This is the first detailed study of the relation between cesarean birth and child cognitive development. We measure differences in child cognitive performance at 4 to 9 years of age between cesarean-born and vaginally-born children (n = 3,666) participating in the Longitudinal Study of Australian Children (LSAC). LSAC is a nationally representative birth cohort surveyed biennially. Using multivariate regression, we control for a large range of confounders related to perinatal risk factors and the socio-economic advantage associated with cesarean-born children. Across several measures, we find that cesarean-born children perform significantly below vaginally-born children, by up to a tenth of a standard deviation in national numeracy test scores at age 8–9. Estimates from a low-risk sub-sample and lower-bound analysis suggest that the relation is not spuriously related to unobserved confounding. Lower rates of breastfeeding and adverse child and maternal health outcomes that are associated with cesarean birth are found to explain less than a third of the cognitive gap, which points to the importance of other mechanisms such as disturbed gut microbiota. The findings underline the need for a precautionary approach in responding to requests for a planned cesarean when there are no apparent elevated risks from vaginal birth.

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population‐based cohort study

“…There is emerging evidence that some birth interventions may have an effect on the neonatal immune response and the child's health in the longer term. 7,29 There is evidence of short-term health impacts for the infant after a cesarean delivery, such as hypothermia, impaired lung function, altered metabolism, altered blood pressure, and altered feeding, which is consistent with our results. 7,27,28 Some of these changes might be due to a lack of labor stress, associated with physiological maladaptation after birth.…”

Type of delivery and reading, writing, and arithmetic learning in twin births

“…This is perhaps because there seems to be no consensus about the benefits and risks of caesarean versus vaginal deliveries for children and mothers alike (Hogle et al, ; Villar et al, ). Some researchers indicate that caesarean sections are associated with lower Apgar scores, neonatal respiratory morbidity, perinatal mortality due to uterine rupture or placenta praevia, placental abruption in subsequent pregnancies, difficulties in maternal‐filial attachment and in neurodevelopment (Asztalos et al, ; Carlander, Edman, Christensson, Andolf, & Wiklund, ; Hogle et al, ; Hyde, Mostyn, Modi, & Kemp, ; Pasupathy & Smith, ; Villar et al, ; Polidano, Zhun, & Bornstein, ; Wallin et al, ), while other studies show that caesarean sections reduce the risk of low 5‐min Apgar scores and intrapartum fetal death of first twins with breech presentations at labour, although it might increase the risk of maternal and neonatal mortality when first twins have a cephalic presentation (Hogle et al, ; Villar et al, ).…”

Establishment of the early-life microbiome: a DOHaD perspective

“…36,38,[118][119][120][121][122] CS-delivered infants are also at a greater risk of childhood asthma, [123][124][125] atopic disease, [126][127][128] allergies, 128,129 obesity, 130 type 1 diabetes mellitus, 131 inflammatory bowel disease, 124,132 and impaired cognition. 133 Some have ascribed this dysbiosis to a lack of exposure to the maternal vaginal microbiota at birth. Indeed, postnatal 'vaginal seeding' (i.e., swabbing of the maternal vaginal fluid across the skin and orifices of the newborn) has been trialled in an attempt to correct this supposed issue.…”