637
Views & Citations10
Likes & Shares
This research measured the variations in
child cognitive performance at 11 to 12 years of age between cesarean-born and
vaginally-born children (n=3750). We use multivariate regression to analyze the
confounders correlated to perinatal risk factors and also the socio-economic
advantage related to cesarean-born children. We discover that cesarean-born
children perform considerably below vaginally-born children, by up to a tenth
of a standard deviation in national examination test scores at the age of 11-12.
Analyze result from a low-risk sub-sample and lower-bound analysis recommend
that the relation is not associated with unobserved confounding. Low
breastfeeding and low maternal health during childbirth cause a child with
cesarean are found to explain less than a 3rd of the cognitive development gap,
that points to the importance of other
variables such as disturbed gut microbiota. The findings underline the
necessity for a preventative approach in responding to requests for a planned
cesarean once there are not any apparent elevated risks from vaginal birth.
Keywords: Maternal, Caesarean birth, Vaginal birth,
Cognitive development, Child health
BACKGROUND
Cesarean birth is correlated with child
cognitive development. The influenced may occur through established links between cesarean
birth and child health conditions, including asthma, type I
diabetes, allergies [1-3] and obesity [4] that are also corelated with lower academic achievement [5,6].
The cesarean procedures also influence the
postnatal maternal health risks [7], which correlated with the child’s
development through altered mother-child interactions [8] and lower rates of
breastfeeding [9]. The other correlation may occur through alterations to the infant’s
gut microbiota. The gut of cesarean-born children was seeded through contact
with the mother’s skin and hospital surfaces, this was different with vaginally
born children whose gut was seeded by passing through the birth canal. After
observed up until age seven, the gut microbiota affecting memory, motivation,
mood and stress reactivity, raises questions about the long-term cognitive
effects of disturbed microbiota composition at a sensitive time in brain
development [10-17]. That process is thought to be a possible caused of
cognitive disorders, like autism spectrum disorder (ASD) and attention deficit
hyperactivity disorder (ADHD), among cesarean-born children [9].
We study the correlation between cesarean
birth and child cognitive development using data from the national academic
examination result in Jakarta, Indonesia, with doing cohort surveyed and
multivariate regression analyzed. There are 3750 respondents participating in
this research. The interviewer administered cognitive tests using the Peabody
Picture Vocabulary Test (PPVT); Who Am I? (WAI) and the Matrix Reasoning test
(MR) to analyze the cognitive level of the 11-12 years child as a second
cognitive achievement measured. These research procedures send to the Public
Health Committee to get review and ethical permit.
RESULT
We find that child cognitive outcomes are
positively influenced with higher educated mothers (bachelor degree), who give
birth at an older age, who are partnered, who have private health insurance,
are employed and have fewer previous births. Consistent with previous studies,
we find a
We also find significant negative influence
between cesarean birth and measures of child cognitive development, up to a
tenth of a standard deviation. Correlative results are shows in all variables,
but only children who have grammar, numeracy, reading, and writing at age
11-12, problem solving (MR) and vocabulary (PPVT) at ages 11-12 are
statistically significant at level 0, 1 or higher. To put the size of these
relations into perspective, a tenth of a standard deviation is similar in
magnitude to the estimated relation between gender and reading at age 8-9 and
effects estimated from improving teacher quality by one standard deviation and
reducing average grade 6 class sizes by ten.
The first stage analysis find that cesarean
birth is significantly associated with lower rates of breastfeeding and higher
rates of obesity and also related with ADD. Second stage results show that
breastfeeding is significantly related with higher cognitive development,
whereas ADD, ASD and obesity are significantly correlated with lower levels of
cognitive development. Combining these results, breastfeeding, obesity and ADD
are found to significantly influence the relation between cesarean birth and child
cognitive outcomes, although the effects size and significance variously.
Individually, the largest mediating effect is through reduced chances of
breastfeeding, which explains 0.008 per- centage points out of the 0.076
percentage point difference (or around 11%) of the gap in grade 6. The total
analyzing result, generated from regressions when all of the variable are
included together between 25% for reading (p=0.052) and 29% for numeracy
(p=0.021) of the estimated difference in cognitive development. This still
leaves at least 70% of the relations unexplained.
DISCUSSION
We find correlation between cesarean birth
and cognitive development in 7 to 9 years child after controlling for the socio-economic
advantage associated with cesarean birth [1,3,9]. Our results are significant
with results from the previous study [7], which found cesarean-born had a 14%
higher risk of being cognitive disorder. Our estimated difference in outcomes
is not large, up to a tenth of a standard deviation in national test scores in
numeracy; they are large enough to warrant action. A 10 of a standard deviation
in national examination scores is comparable in size to differences related to
gender, class size and teacher quality that are the focus of policy effort. We
suggest taking a precautionary approach about birth plans, especially when
there are no health risks from vaginal birth. Informing the risks and benefits
of cesarean birth should be a priority.
There are 2 important results of this study.
First, the sensitivity analysis finding bias from unobserved confounding is
unlikely to explain the results completely and that causal relations are
plausible. This does not mean that there are causal relations because bias from
unobserved confounding is still possible. Inheritable genetic traits as a
perinatal risk was not controlled as a confounder, for example a lack of
maternal height may drive both cesarean birth (due to a small pelvis size
(cephalopelvic disproportion)) [9] and child cognitive outcomes [16]. Second,
the periods of relations persist long-term and are not confined to children
with problems. The results open the possibility that direct mechanisms, such as
disturbed gut microbiota, may be important. However, this research cannot
rule-out the possibility that at least some of the residual effect is due to
measurement error, for example, under-reporting of the presence of health
conditions by the care giver, was biased by unobserved confounding.
CONCLUSION
The result in this study should motivate more
research that may focus instead on instrumental variables estimation using
large-scale linked hospital and child development administrative records that
exploits natural experiments. A limitation of this method is that the results
only have a local treatment interpretation and cannot be generalized to those
unaffected by the random event that led to assignment. A precautionary approach
when formulating birth plans is important, especially when there are no health
risks from vaginal birth. The medical practitioners have to informing of the
risks and benefits of cesarean birth, which may be formalized by incorporating
education sessions into practitioner’s procedure.
- Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, et al. (2008) Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: A meta-analysis of observational studies. Diabetologia 51: 726-735.
2. Cho CE, Norman M (2013) Cesarean section and development of the
immune system in the off- spring. Am J Obstet Gynecol 208: 249-254.
3. Thavagnanam S, Fleming J, Bromley A, Shields M, Cardwell CA (2008)
Meta-analysis of the association between caesarean section and childhood
asthma. Clin Exp Allergy 38: 629-633.
4. Li H, Zhou Y, Liu J (2013) The impact of cesarean section on
offspring overweight and obesity: A systematic review and meta-analysis. Int J
Obes 37: 893-899.
5. Taras H, Potts DW (2005) Chronic health conditions and student
performance at school. J Sch Health 75: 255-266.
6. Taras H, Potts DW (2005) Obesity and student performance at school.
J Sch Health 75: 291-295.
7. Liu S, Heaman M, Joseph KS, Liston RM, Huang L, et al. (2005) Risk
of maternal postpartum readmission associated with mode of delivery. Obstet
Gynecol 105: 836-842.
8. Kelly Y, Sacker A, Del Bono E, Francesconi M, Marmot M (2011) What
role for the home learning environment and parenting in reducing the
socioeconomic gradient in child development? Findings from the Millennium
Cohort Study. Arch Dis Child 96: 832-837.
9. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, et al. (2008) Breastfeeding and child cognitive
development: New evidence from a large randomized trial. Arch Gen Psychiatry
65: 578-584.
10. Gibbons L, José MB, Jeremy AL, Ana PB, Fernando A, et al. (2010)
The global numbers and costs of additionally needed and unnecessary caesarean
sections performed per year: Overuse as a barrier to universal coverage. World
Health Report 30: 1-31.
11. OECD (2011) Health at a glance. Paris.
12. Bailit JL, Love TE, Mercer B (2004) Rising cesarean rates: Are
patients sicker? Am J Obstet Gynecol 191: 800-803.
13. Einarsdóttir K, Anthony S, Rachael E, Fatima AH, Anna K, et al.
(2012) Increase in caesarean deliveries after the Australian private health
insurance incentive policy reforms. PLos One 7: e41436.
14. O’Leary C, Pennell C, York L, Mulroy S, Stanley FJ, et al. (2007)
Trends in mode of delivery during 1984-2003: Can they be explained by pregnancy
and delivery complications? BJOG 114: 855-864.
15. Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL (2011)
Epidemiology and trends for caesarean section births in New South Wales,
Australia: A population-based study. BMC pregnancy and childbirth 11: 1-7.
16. Habiba M, Kaminski M, Da Frè M, Marsal K, Bleker O, et al. (2006)
Caesarean section on request: A comparison of Obstetricians attitudes in eight
European countries. BJOG 113: 647-656.
17. Halla M, Mayr H, Pruckner G, García GP (2016) Cutting fertility?
The effect of cesarean deliveries on subsequent fertility and maternal labor
supply. Institute for the Study of Labor Discussion Paper No. 9905, Bonn.
-
Table 1 -
Table 2
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- Journal of Agriculture and Forest Meteorology Research (ISSN:2642-0449)
- Food and Nutrition-Current Research (ISSN:2638-1095)
- Proteomics and Bioinformatics (ISSN:2641-7561)
- Journal of Veterinary and Marine Sciences (ISSN: 2689-7830)
- Advances in Nanomedicine and Nanotechnology Research (ISSN: 2688-5476)
- Journal of Astronomy and Space Research
- Journal of Microbiology and Microbial Infections (ISSN: 2689-7660)
