Sukainah Y Al Khalaf1, Sinéad M O'Neill2,3, Linda M O'Keeffe4,5, Tine B Henriksen6, Louise C Kenny3, John F Cryan7, Ali S Khashan8,9. 1. Department of Epidemiology and Public Health, University College Cork, Fourth Floor, Western Gate Building, Cork, Ireland. 2. Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre (NPEC), Cork University Maternity Hospital, Wilton, Cork, Ireland. 3. Department of Obstetrics and Gynaecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. 4. Department of Epidemiology and Public Health, University College Cork, Fourth Floor, Western Gate Building, Cork, Ireland. l.okeeffe@ucc.ie. 5. Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre (NPEC), Cork University Maternity Hospital, Wilton, Cork, Ireland. l.okeeffe@ucc.ie. 6. Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark. 7. Department of Anatomy and Neuroscience, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland. 8. Department of Epidemiology and Public Health, University College Cork, Fourth Floor, Western Gate Building, Cork, Ireland. a.khashan@ucc.ie. 9. Department of Obstetrics and Gynaecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. a.khashan@ucc.ie.
Abstract
PURPOSE: We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates. METHODS: Families with infants born between December 2007 and May 2008 (N = 11,134) were randomly selected and recruited to the Growing Up in Ireland study. Mode of delivery was classified into spontaneous vaginal delivery; instrumental vaginal delivery; emergency Cesarean section (CS); and elective CS. The 'Ages and Stages Questionnaire' was completed at age 9-months and the 'Strengths and Difficulties Questionnaire' at 3 years. Data were weighted to represent the national sample (N = 73,662) and multivariate logistic regression was used for the statistical analyses. RESULTS: At age 9 months, elective CS was associated with a delay in personal social skills [adjusted odds ratio, aOR 1.24; (95% confidence interval, CI 1.04, 1.48)] and gross motor function [aOR 1.62, (95% CI 1.34, 1.96)], whereas emergency CS was associated with delayed gross motor function [aOR 1.30, (95% CI 1.06, 1.59)]. At age 3 years there was no significantly increased risk of an abnormal total SDQ score across all modes of delivery. CONCLUSIONS: Children born by elective CS may face a delay in cognitive and motor development at age 9 months. No increase in total SDQ score was found across all modes of delivery. Further investigation is needed to replicate these findings in other populations and explore the potential biological mechanisms.
PURPOSE: We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates. METHODS: Families with infants born between December 2007 and May 2008 (N = 11,134) were randomly selected and recruited to the Growing Up in Ireland study. Mode of delivery was classified into spontaneous vaginal delivery; instrumental vaginal delivery; emergency Cesarean section (CS); and elective CS. The 'Ages and Stages Questionnaire' was completed at age 9-months and the 'Strengths and Difficulties Questionnaire' at 3 years. Data were weighted to represent the national sample (N = 73,662) and multivariate logistic regression was used for the statistical analyses. RESULTS: At age 9 months, elective CS was associated with a delay in personal social skills [adjusted odds ratio, aOR 1.24; (95% confidence interval, CI 1.04, 1.48)] and gross motor function [aOR 1.62, (95% CI 1.34, 1.96)], whereas emergency CS was associated with delayed gross motor function [aOR 1.30, (95% CI 1.06, 1.59)]. At age 3 years there was no significantly increased risk of an abnormal total SDQ score across all modes of delivery. CONCLUSIONS:Children born by elective CS may face a delay in cognitive and motor development at age 9 months. No increase in total SDQ score was found across all modes of delivery. Further investigation is needed to replicate these findings in other populations and explore the potential biological mechanisms.
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