The association between caesarean section and cognitive ability in childhood
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ORIGINAL PAPER
The association between caesarean section and cognitive ability in childhood Michael Hanrahan1 · Fergus P. McCarthy2,3 · Gerard W. O’Keeffe4 · Ali S. Khashan1,2 Received: 14 May 2019 / Accepted: 11 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose Global rates of caesarean section (CS) rates have increased rapidly in recent years. This is a growing public health concern as it has been proposed that CS may impact cognitive outcomes in childhood. However, the evidence for this association is limited and inconsistent. Therefore, the aim of this study was to investigate the relationship between obstetric mode of delivery and longitudinal cognitive outcomes in childhood. Methods We examined this question using data from a longitudinal cohort study of 8845 participants from the Millennium Cohort Study, a nationally representative UK cohort, who completed a range of verbal and visual-spatial cognitive assessments at ages 3, 5, 7 and 11 years. Results We found a statistically significant association between planned CS and visual-spatial cognitive delay in the pattern construction assessment at age 5 (OR 1.31, 95% CI 0.99–1.72) and age 7 (OR 1.42, 95% CI 1.12–1.81). Additionally planned CS was also associated with increased odds of “early childhood delay” (OR 1.70, 95% CI 1.15–2.50) and borderline increased odds of “persistent delay” (OR 1.37, 95% CI 0.99–1.89) in visual-spatial cognitive tests. Mode of delivery was not associated with verbal ability or with patterns of delay at any age point in verbal cognitive tests. Conclusion We have reported a small association between planned CS and visual-spatial cognitive delay in childhood. However, while this result should be interpreted with caution, it highlights the need to further explore this potential relationship and the causal basis of such an association. Keywords Caesarean section · Obstetric mode of delivery · Cognitive ability
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-019-01798-4) contains supplementary material, which is available to authorized users. * Ali S. Khashan [email protected] 1
School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
2
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
3
Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
4
Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
The World Health Organisation recommends a 15% ceiling of births by caesarean section (CS) [1]. However, globally the rate of CS has increased rapidly [2] and in the UK it has risen from 21.4% in 2000 to 26.4% in 2013 [3]. This is a concern as it is uncertain what long-term sequelae may result [4]. Moreover, given the high incidence of CS, small increases in the risk of adverse outcomes may have a large effect on the population [5]. One outcome that is of increasing i
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