Type of Delivery, Neuropsychological Development and Intelligence in Twin Births

Abstract

Based on a retrospective cohort design with 6-year-old children born in twin births, the relationship between verbal, non-verbal, global neuropsychological development, general intelligence and type of delivery has been studied. To this end, the possible effect of third gestational, obstetric and neonatal variables, such as maternal age at delivery, fetal presentation, gestational age, newborn weight and Apgar at minute one, was controlled. The exposed cohort includes children born by cesarean section, and the unexposed cohort is composed of children born vaginally with or without induction. A total of 124 children were evaluated in their 1st year of primary school using the Child Neuropsychological Maturity Questionnaire, Kaufman’s Intelligence Test and the medical histories of the children collected after birth. By means of binary logistic regression analysis, it has been found that the type of delivery is presented as an independent risk factor for disorders in verbal, non-verbal and global development and for the general intellectual difficulties of children born of multiple births. These results suggest the need to analyze in future prospective studies with broader samples the relationship between different types of obstetric and perinatal variables of birth type and infant neuropsychological development and general intelligence, in order to prevent possible psychological alterations from birth.

The Impact of Cesarean and Vaginal Delivery on Results of Psychological Cognitive Test in 5 Year Old Children

“…The observed results were not affected by any of the tested confounders. These outcomes correspond to those from studies by Polidano et al [ 7 ], Curran et al [ 10 ], and Gonzales-Valenzuela et al [ 11 ]. Potential effects of the type of delivery on cognitive development in children should also be followed in our cohorts in the future to see if the observed changes are long-lasting or if they disappear at a later age.…”

“…The impact of the two different modes of delivery on neuropsychological development was also investigated by Gonzales-Valenzuela et al [ 11 ] who compared vaginal ( n = 84) and cesarean delivery ( n = 40) in 6 year old children born in twin births. Children were evaluated in their first year of primary school, using the Child Neuropsychological Maturity Questionnaire and Kaufman’s Intelligence Test.…”

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

“…Therefore, in multiple deliveries requiring a caesarean section, there are some circumstances interfering in children's neurological development that could explain, at least partially, the long‐term cognitive and linguistic difficulties typically found in children with LDs in reading, writing, and arithmetic. In recent studies, type of birth has been found to be associated as an independent risk factor with neuropsychological development disorders and intellectual difficulties (González‐Mesa et al, ; González‐Valenzuela et al, ).…”

“…In fact, although some studies have reported a greater risk of mortality in the second twin following vaginal delivery when compared to the co‐twin (Armson et al, ; Wen et al, , ; Yang et al, ) other studies have been unable to demonstrate any benefits of elective caesarean in relation to vaginal delivery of the second twin (Greig, Veille, Morgan, & Henderson, ; Guerra et al, ; Hogle, Hutton, McBrien, Barret, & Hanna, ; Rabinovici, Barkai, Reichman, Serr, & Mashiach, ). Furthermore, the risks of caesarean delivery versus spontaneous vaginal delivery include low Apgar scores, neonatal respiratory morbidity, perinatal mortality due to uterine rupture or placenta praevia, and placental abruption in subsequent pregnancies (González‐Valenzuela, González‐Mesa, Cazorla‐Granados, & López‐Montiel, ; Hogle et al, ; Pasupathy & Smith, ; Villar et al, ; Wallin, Ekström, Marsal, & Källén, ). However, some studies seem to show that caesarean sections reduce the risk of low 5‐min Apgar scores and intrapartum fetal death of the first twin with breech presentation at labor, but they increase the risk of maternal and neonatal mortality and morbidity in cases of cephalic presentation (Hogle et al, ; Villar et al, ).…”

“…Although there are studies reporting the risks of multiple births and the links between perinatal factors and school LDs, fewer researchers have considered twins as a special psychologically and academically vulnerable population, taking into account the type of delivery as a risk factor for psychological disorders (González‐Mesa et al, ; González‐Valenzuela et al, ).…”