The relationship between cesarean delivery with long term morbidity in children
An important and interesting study (PMID 31461150), published on August 28, 2019, on an excellent journal. It was aimed to explore the association between cesarean delivery and long term illness (such as neurodevelopmental and psychiatric disorders), in offsprings.
Cesarean delivery lowers obstetric complications in mothers and children, when done following specific medical indications. In the last three decades, the rate of cesarean delivery in the world had risen from 6% in 1990 to 21% (!) in 2015. A large number of these surgeries were not done under a clear medical indication (for example, due to maternal request).
Many studies had linked cesarean delivery to long term morbidities in children, such as obesity, allergies and asthma, insulin dependent diabetes mellitus (type 1 diabetes) and even a certain kind of leukemia. In addition, cesarean section is also associated with developmental disorders, such as conduct behavior, psychiatric disorders and autism.
This is a meta-analysis study that systematically summarizes data from previous studies in this subject.
Results – In the end of the long process of tracking the suitable studies, 61 studies were found, with data on over 20 million births, in 19 different countries. Cesarean delivery was found to have increased odds (by 17%, compared with vaginal delivery) to a child with autism and attention deficit hyperactivity disorder (ADHD). In addition, high prevalence of developmental delay, mental retardation, obsessive compulsive disorder, tics and eating disorders was found, though the last four conditions did not reach a significant statistical difference between the two groups.
So far I would say that these findings are interesting, but the more important question (in my opinion) is the reason for cesarean delivery and the association with long term morbidity.
It is clear to me, that in the case of emergency and of maternal / fetal distress, there is no doubt in the need to progress to emergent cesarean delivery, with all the statistical consequences for some kind of morbidity in the far away future.
This raises a more important question – is there a difference in the long term morbidity in those cases of emergent cesarean delivery when comparing them with elective cesarean delivery? (Which in most cases are done because of maternal requenst and not under medical indication).
Only 18-20 studies reported data on the comparison, but still, data of over 10 million births were analyzed. Well, even elective cesarean delivery, as well as emergent operations, was correlated with higher prevalence of autism, and ADHD.
Discussion – This study’s result, as well as other studies and observations, correlating cesarean delivery with a spectrum of behavioral and psychiatric conditions. In addition, for the first time in professional literature, enough data was collected, to link indications for cesarean delivery with long term effects. In both main variables found (autism and ADHD), high prevalence was noted in children born in cesarean delivery compering with vaginal delivery, with no difference in children born through elective or emergent delivery.
The author mentions many causes that may affect the results of the study, and are aware of the fact that there may be other causes that can explain the difference between the two groups (confounders).
Naturally more research is needed, more specific and accurate (maybe in the level of family genetics), to explain and determine conclusively, if in fact the cesarean section itself Is the cause for the long term morbidity.
Moreover, besides assumptions, there is no explanation to this observation, and more research is needed.
Practically, what does this say to us as parents? Do we need to cancel all elective cesarean sections that are due to the family’s desire?
Of course not.
Sometimes, the reason is important, and vaginal delivery may cause more damage (mentally and psychosocially) to a family, than a theoretical long term risk. Indeed, the results of this study must be considered thoroughly, on the level of the medical decision maker in the country (department of health, or even inside the OB/GYN department), and must be taken into consideration by parents considering elective cesarean delivery.
Good luck!
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