Cesarean Section Due to Social Factors Affects Children's Psychology and Behavior: A Retrospective Cohort Study

Influence of Mode of Delivery on Children's Attention Deficit Hyperactivity Disorder and Childhood Intelligence

OBJECTIVE

To investigate whether differences exist in attention deficit hyperactivity disorder (ADHD) and intelligence between children born by cesarean delivery and those born by vaginal delivery.

METHODS

This retrospective study included singleton children that were born between January 2013 and December 2014. The Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48) was required on the probability of psychological and behavioral problems. The China-Wechsler Intelligence Scale for Children (C-WIRS) was used for evaluation of crystallized intelligence and Raven's Standard Progressive Matrices for evaluation of fluid intelligence.

RESULTS

A total of 10,568 valid questionnaires were obtained. CPRS-48 ADHD index and detection rate were higher in cesarean delivery group than those in vaginal delivery group. Cesarean delivery groups had a lower performance intelligence quotient score according to C-WISC.

CONCLUSION

Children born by cesarean delivery were more likely to have a risk of ADHD and a lower performance intelligence quotient compared with those born by vaginal delivery.

Infant inflammation predicts childhood emotional and behavioral problems and partially mediates socioeconomic disadvantage

BACKGROUND

Emotional and behavioral problems (EBP) are common in children. Environmental factors like socioeconomic disadvantage influence EBP pathogenesis and can trigger inflammation. However, the link between early inflammation-EBP in children is unclear. We investigated the associations between i) infant inflammatory biomarkers and subsequent EBP and ii) early life environmental factors and EBP and assessed whether infant inflammation mediated these associations.

METHODS

Inflammatory biomarkers glycoprotein acetyls (GlycA) and high-sensitivity C-reactive protein (hsCRP) were quantified at birth and 12 months in a population-derived birth cohort, the Barwon Infant Study. Early life factors including demographic, prenatal, and perinatal factors were collected from antenatal to the two-year period. Internalizing and externalizing problems at age two were measured by the Child Behavior Checklist. Prospective associations were examined by multivariable regression analyses adjusted for potential confounders. Indirect effects of early life factors on EBP through inflammation were identified using mediation analyses.

RESULTS

Elevated GlycA levels at birth (GlycAbirth) were associated with greater internalizing problems at age two (β = 1.32 per SD increase in GlycA; P = 0.001). Inflammation at birth had a stronger magnitude of effect with later EBP than at 12 months. GlycAbirth partially mediated the associations between lower household income (6%), multiparity (12%) and greater number of older siblings (13%) and EBP. Patterns were less evident for hsCRP or externalizing problems.

CONCLUSIONS

GlycAbirth was positively associated with EBP at age two and partially mediated the association between several indicators of socioeconomic disadvantage and EBP. Prenatal and perinatal inflammation may be relevant to early neurodevelopment and emotional health.