Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
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Abstract
Objectives
Previous studies have reported that mode of delivery, particularly cesarean delivery (CD), is associated with neurodevelopmental outcomes in children. This study evaluates behavioral and neuropsychological test scores in children based on mode of delivery.
Methods
Children enrolled in the Raine Study from Western Australia, born between 1989 and 1992 by instrumental vaginal delivery (IVD), elective CD, and non-elective CD, were compared to those with spontaneous vaginal delivery (SVD). The primary outcome was the Child Behavior Checklist (CBCL) administered at age 10. Secondary outcomes included evaluations of language, motor function, cognition, and autistic traits. Multivariable linear regression was used to evaluate score differences by mode of delivery adjusted for sociodemographic and clinical characteristics, and Poisson regression was used to evaluate for increased risk of clinical deficit.
Results
Of 2,855 children, 1770 (62.0 %) were delivered via SVD, 480 (16.8 %) via IVD, 346 (12.1 %) via elective CD, and 259 (9.1 %) via non-elective CD. Non-elective CD was associated with higher (worse) CBCL Internalizing (+2.09; 95 % CI 0.49, 3.96; p=0.01) scores, and elective CD was associated with lower (worse) McCarron Assessment of Neuromuscular Development (MAND) (−3.48; 95 % CI −5.61, −1.35; p=0.001) scores. Differences were not seen in other outcomes, and increased risk of clinical deficit was not observed with either the CBCL Internalizing or MAND scores.
Conclusions
Differences in behavior and motor function were observed in children delivered by CD, but given that score differences were not associated with increased incidence of clinical deficit, clinical significance may be limited.
Funding source: Raine Medical Research Foundation
Funding source: Agency for Healthcare Research and Quality
Award Identifier / Grant number: R01HS026493
Funding source: Women and Infants Research Foundation
Funding source: National Health and Medical Research Council
Award Identifier / Grant number: 2009322
Award Identifier / Grant number: APP1173896
Acknowledgments
We would like to acknowledge the Raine Study participants and their families for their ongoing participation in the study and the Raine Study team for study co-ordination and data collection. We also thank the NHMRC and the Raine Medical Research Foundation for their long term contribution to funding the study over the last 30 years. The core management of the Raine Study is funded by The University of Western Australia, Curtin University, Telethon Kids Institute, Women and Infants Research Foundation, Edith Cowan University, Murdoch University and The University of Notre Dame Australia. The Raine Study Gen1-and Gen2-antenatal and perinatal data collections are funded by the Raine Medical Research Foundation. The Raine Study Gen2-10-year follow-up and the autism quotient data of the Gen2-20-year follow-up are funded by the NHMRC and the Raine Medical Research Foundation.
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Research ethics: This study was approved by the Institutional Review Board at Columbia University Irving Medical Center, with the requirement of written informed consent waived. Data collection and storage were approved by Ethics Committees at King Edward Memorial Hospital, Princess Margaret Hospital, and the University of Western Australia.
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Informed consent: Not applicable.
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Author contributions: Study design and conceptualization: AM, RT, RL, BVUS, AW, GL, CP, CI. Statistical analysis: ZY, OI, CM, GL, CI. Interpretation of data: all authors. Drafting of manuscript: AM, CI. Critical revision of manuscript: all authors. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflicts of interest.
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Research funding: The Raine Study is funded by project and program grants from the National Health and Medical Research Council of Australia (NHMRC, Canberra, Australia). Core management funding is provided by the Raine Medical Research Foundation, the Telethon Kids Institute, the University of Western Australia (UWA), the Women and Infants Research Foundation, Curtin University, Murdoch University, Edith Cowan University, and the University of Notre Dame Australia. Dr. Caleb Ing is supported by the Agency for Healthcare Research and Quality (AHRQ) under award number R01HS026493. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. Professor Andrew Whitehouse is supported by an Investigator Grant from the National Health and Medical Research Council (APP1173896). Professor Britta S. von Ungern-Sternberg is supported by the Stan Perron Charitable Foundation and through a National Health and Medical Research Council Investigator Grant (2009322).
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Data availability: The data that support the findings of this study are available from The Raine Study. Restrictions apply to the availability of these data, which were used under license for this study. Data are available with the permission of The Raine Study from https://rainestudy.org.au/information-for-researchers/available-data.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/jpm-2024-0188).
© 2024 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Review
- The utilization of artificial intelligence in enhancing 3D/4D ultrasound analysis of fetal facial profiles
- Commentary
- Respect for history: an important dimension of contemporary obstetrics and gynecology
- Opinion Papers
- Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
- Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding – clinical implications and perspectives
- Original Articles – Obstetrics
- The potential impact of universal screening for vasa previa in the prevention of stillbirths
- Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter
- Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy
- Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women
- Complementary and Alternative Medicine use among pregnant women attending antenatal clinic: a point to ponder
- Molecular evidence that GBS early neonatal sepsis results from ascending infection: comparative hybrid genomics analyses show that microorganisms in the vaginal ecosystem, amniotic fluid, chorioamniotic membranes, and neonatal blood are the same
- Original Articles – Fetus
- Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn
- New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus
- Original Articles – Neonates
- Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
- Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men
- Letter to the Editor
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