Research Review: Birth by caesarean section and development of autism spectrum disorder and attention‐deficit/hyperactivity disorder: a systematic review and meta‐analysis

Abstract

Delivery by CS is associated with a modest increased odds of ASD, and possibly ADHD, when compared to vaginal delivery. Although the effect may be due to residual confounding, the current and accelerating rate of CS implies that even a small increase in the odds of disorders, such as ASD or ADHD, may have a large impact on the society as a whole. This warrants further investigation.

Obstetrical Mode of Delivery and Childhood Behavior and Psychological Development in a British Cohort

“…Some studies have linked birth by CS to an increased risk of autism spectrum disorders (ASD) (Hultman et al 2002), attention-deficit/hyperactivity disorder (ADHD) (Silva et al 2014) and behavioral difficulties (Kelmanson 2013) but results have been inconsistent (Burstyn et al 2010;Ketzer et al 2012). A recent meta-analysis reported that CS was associated with a 23 % increased risk of ASD compared to vaginal delivery (VD) (Curran et al 2014), however, the included studies were limited. For example, few studies distinguished between elective and emergency CS.…”

“…Though, a more recent population-based sibling control study reported that any association may be caused by familial confounding rather than be a causal effect (Curran et al 2015). A review of the association between CS and ADHD found the evidence was very limited and inconclusive (Curran et al 2014). There are several hypotheses regarding how CS may affect behavioral development, including ''early term '' birth (MacKay et al 2010;Tita et al 2009), exposure to altered microbiota (Cho and Norman 2013;Cryan and Dinan 2012;Desbonnet et al 2014;Hsiao et al 2013;Salminen et al 2004), or possibly through changes in maternal-child attachment (Brumariu and Kerns 2010;Olza Fernandez et al 2013;Swain et al 2008).…”

Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder

“…The objective of this investigation was to assess the effect of mode of delivery, specifically birth by CS, on ASD using data from a large Swedish population-based registry. To our knowledge, this is the largest study on this subject to date 7 and the only one to use the combination of adjusted cohort and sibling control study designs. Using this combination and taking familial environmental and genetic confounding factors into consideration, we aimed to robustly assess any association between mode of delivery and ASD.…”

“…11 The observed association may alternatively be due to residual confounding or confounding by indication, meaning ASD could be associated with the indication for CS rather than the CS itself, 7 or to an unknown genetic factor that is associated with increased risk of CS and ASD. The prevalence of birth by CS is estimated to be 15% worldwide and is more than 20% in developed countries.…”

Fatores associados à cesariana segundo fonte de financiamento na Região Sudeste: estudo transversal a partir dos dados de pesquisa 'Nascer no Brasil' Inquérito Nacional sobre Parto e Nascimento

“…Razões para o insucesso na redução das mortes maternas incluem a prática frequente de cesarianas sem indicações clínicas [11][12][13] . Além de morbidades a curto prazo e aumento da mortalidade, pesquisas descreveram desfechos adversos a longo prazo para filhos de mães submetidas à cesárea, tais como: diabetes do tipo 1 14 , obesidade 15 , esclerose múltipla 16 , autismo, déficit de atenção e hiperatividade 17 . Alguns dos desfechos começaram a ser explicados por meio do impacto da cesariana e das intervenções associadas à cirurgia sobre a modulação epigenética de cada indivíduo 18 , assim como o microbioma 19 .…”