Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Coh
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ORIGINAL ARTICLE
Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study Lea Takács1,2 · Samuel P. Putnam3 · Catherine Monk4,5 · Hannah G. Dahlen9 · Charlene Thornton9 · František Bartoš1 · Anastasia Topalidou6 · Lilian L. Peters7,8,9 Received: 8 May 2020 / Revised: 19 August 2020 / Accepted: 13 October 2020 © The Author(s) 2020
Abstract The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children’s Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes. Keywords Cesarean section · Development · Behavior · Temperament · Pre-school
Introduction In the last few decades, rates of Cesarean section (CS) have risen dramatically. In the United States, the CS rate was 32% in 2015, which is 11% higher than in 1996 [1]. In Europe, the CS rate increased from 11.2 to 25% between 1990 and 2014 [2], rising in almost all countries except for Iceland and Finland. The highest CS rate is reported for Latin America Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10578-020-01084-4) contains supplementary material, which is available to authorized users. * Lea Takács [email protected] 1
Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
2
Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA
3
Department of Psychology, Bowdoin College, Brunswick, ME, USA
4
Department of Obstetrics & Gynecology, and Psychiatry, Columbia University, New York, NY, USA
5
New York State Psychiatric Institute, New York, NY, USA
and the Caribbean region (40.5%), though there have been significant increases in many Asian countries as well (from 4.4 to 19.5% between 1990 and 2014) [2]. This rise in CS rates is partly associated with factors that are difficult to change, such as increasing maternal age at first birth [3] and maternal obesity [4]. However, there are other factors that may be easier to alter, such as maternal preference, medical models of care, or funding mechanisms that encourage more frequent intervention in birth. Indeed, after adopting a single, blended payment policy for uncomplicated CS and vaginal births, a decline
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