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Chen M, Lin Y, Yu C, Fu R, Shentu H, Yao J, Huang J, He Y, Yu M. Effect of cesarean section on the risk of autism spectrum disorders/attention deficit hyperactivity disorder in offspring: a meta-analysis. Arch Gynecol Obstet 2024; 309:439-455. [PMID: 37219611 DOI: 10.1007/s00404-023-07059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to investigate the relationship between cesarean section (CS) offspring and autism spectrum disorders (ASD)/attention deficit hyperactivity disorder (ADHD). METHODS Searching of the databases (PubMed, Web of Science, Embase, and Cochrane Library) for studies on the relationship between mode of delivery and ASD/ADHD until August 2022. The primary outcome was the incidence of ASD/ADHD in the offspring. RESULTS This meta-analysis included 35 studies (12 cohort studies and 23 case-control studies). Statistical results showed a higher risk of ASD (odds ratio (OR) = 1.25, P < 0.001) and ADHD (OR = 1.11, P < 0.001) in CS offspring compared to the VD group. Partial subgroup analysis showed no difference in ASD risk between CS and VD offspring in sibling-matched groups (OR = 0.98, P = 0.625). The risk of ASD was higher in females (OR = 1.66, P = 0.003) than in males (OR = 1.17, P = 0.004) in the CS offspring compared with the VD group. There was no difference in the risk of ASD between CS under regional anesthesia group and VD group (OR = 1.07, P = 0.173). However, the risk of ASD was higher in the CS offspring under general anesthesia than in the VD offspring (OR = 1.62, P < 0.001). CS offspring developed autism (OR = 1.38, P = 0.011) and pervasive developmental disorder-not otherwise specified (OR = 1.46, P = 0.004) had a higher risk than VD offspring, but there was no difference in Asperger syndrome (OR = 1.19, P = 0.115). Offspring born via CS had a higher incidence of ADHD in different subgroup analyses (sibling-matched, type of CS, and study design). CONCLUSIONS In this meta-analysis, CS was a risk factor for ASD/ADHD in offspring compared with VD.
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Affiliation(s)
- Meiling Chen
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yeting Lin
- Anesthesiology Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Chiyuan Yu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haojie Shentu
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jie Yao
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianing Huang
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengjiao Yu
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, 998 North Qianhe Road, Yinzhou District, Ningbo, 315100, Zhejiang, China.
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King J. Are there adverse outcomes for child health and development following caesarean section delivery? Can we justify using elective caesarean section to prevent obstetric pelvic floor damage? Int Urogynecol J 2021; 32:1963-1969. [PMID: 33877375 DOI: 10.1007/s00192-021-04781-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Elective pre-labour Caesarean section (CS) delivery is widely regarded as the panacea for all pelvic floor dysfunction despite substantial epidemiological evidence that it is only partially protective. To demand a CS is also considered a right for the well-counselled patient, even without an elevated risk of incontinence or prolapse. In recent years there has been increasing data on possible adverse health outcomes for children delivered by CS over those delivered vaginally. This includes respiratory illness, atopic conditions, obesity, diabetes and other severe auto-immune diseases. Concern has also been raised over possible impacts on cognitive and neuropsychological development in these children. Often the response has been to dismiss these outcomes as a result of the indication for the CS birth such as antenatal compromise or maternal disease. However the marked increase in non-medical Caesarean delivery throughout many regions of the world has allowed us to better distinguish these contributing factors. METHODS This narrative review looks at some of the more recent evidence on adverse health and developmental outcomes associated with CS, particularly pre-labour CS and the implications for the long term health of our society. RESULTS Epidemiological studies and animal research indicate an increased risk of negative impacts on child physical health and neuro-cognitive development aftercaesarean section delivery, particularly pre-labour Caesarean section, compared with vaginal delivery. This elevated risk persists after correction forobstetric and maternal factors. CONCLUSION Caesarean section delivery can result in adverse outcomes for infant, maternal and societal wellbeing. Elective Caesarean section, purely to potentially minimise pelvic floor dysfunction, cannot be justified.
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Affiliation(s)
- Jennifer King
- Pelvic Floor Unit, Westmead Hospital, Sydney, Australia.
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Deoni SC, Adams SH, Li X, Badger TM, Pivik RT, Glasier CM, Ramakrishnaiah RH, Rowell AC, Ou X. Cesarean Delivery Impacts Infant Brain Development. AJNR Am J Neuroradiol 2019; 40:169-177. [PMID: 30467219 DOI: 10.3174/ajnr.a5887] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/06/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The cesarean delivery rate has increased globally in the past few decades. Neurodevelopmental outcomes associated with cesarean delivery are still unclear. This study investigated whether cesarean delivery has any effect on the brain development of offspring. MATERIALS AND METHODS A total of 306 healthy children were studied retrospectively. We included 3 cohorts: 2-week-old neonates (cohort 1, n = 32/11 for vaginal delivery/cesarean delivery) and 8-year-old children (cohort 2, n = 37/23 for vaginal delivery/cesarean delivery) studied at Arkansas Children's Hospital, and a longitudinal cohort of 3-month to 5-year-old children (cohort 3, n = 164/39 for vaginal delivery/cesarean delivery) studied independently at Brown University. Diffusion tensor imaging, myelin water fraction imaging, voxel-based morphometry, and/or resting-state fMRI data were analyzed to evaluate white matter integrity, myelination, gray matter volume, and/or functional connectivity, respectively. RESULTS While not all MR imaging techniques were shared across the institutions/cohorts, post hoc analyses showed similar results of potential effects of cesarean delivery. The cesarean delivery group in cohort 1 showed significantly lower white matter development in widespread brain regions and significantly lower functional connectivity in the brain default mode network, controlled for a number of potential confounders. No group differences were found in cohort 2 in white matter integrity or gray matter volume. Cohort 3 had significantly different trajectories of white matter myelination between groups, with those born by cesarean delivery having reduced myelin in infancy but normalizing with age. CONCLUSIONS Cesarean delivery may influence infant brain development. The impact may be transient because similar effects were not observed in older children. Further prospective and longitudinal studies may be needed to confirm these novel findings.
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Affiliation(s)
- S C Deoni
- School of Engineering (S.C.D.), Brown University, Providence, Rhode Island
| | - S H Adams
- From the Arkansas Children's Nutrition Center (S.H.A., T.M.B., R.T.P., X.O.), Little Rock, Arkansas
- Pediatrics (S.H.A., T.M.B., R.T.P., C.M.G., X.O.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - X Li
- Departments of Radiology (X.L., C.M.G., R.H.R., A.C.R., X.O.)
| | - T M Badger
- From the Arkansas Children's Nutrition Center (S.H.A., T.M.B., R.T.P., X.O.), Little Rock, Arkansas
- Pediatrics (S.H.A., T.M.B., R.T.P., C.M.G., X.O.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - R T Pivik
- From the Arkansas Children's Nutrition Center (S.H.A., T.M.B., R.T.P., X.O.), Little Rock, Arkansas
- Pediatrics (S.H.A., T.M.B., R.T.P., C.M.G., X.O.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - C M Glasier
- Departments of Radiology (X.L., C.M.G., R.H.R., A.C.R., X.O.)
- Pediatrics (S.H.A., T.M.B., R.T.P., C.M.G., X.O.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Research Institute (C.M.G., R.H.R., A.C.R., X.O.), Little Rock, Arkansas
| | - R H Ramakrishnaiah
- Departments of Radiology (X.L., C.M.G., R.H.R., A.C.R., X.O.)
- Arkansas Children's Research Institute (C.M.G., R.H.R., A.C.R., X.O.), Little Rock, Arkansas
| | - A C Rowell
- Departments of Radiology (X.L., C.M.G., R.H.R., A.C.R., X.O.)
- Arkansas Children's Research Institute (C.M.G., R.H.R., A.C.R., X.O.), Little Rock, Arkansas
| | - X Ou
- From the Arkansas Children's Nutrition Center (S.H.A., T.M.B., R.T.P., X.O.), Little Rock, Arkansas
- Departments of Radiology (X.L., C.M.G., R.H.R., A.C.R., X.O.)
- Pediatrics (S.H.A., T.M.B., R.T.P., C.M.G., X.O.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Research Institute (C.M.G., R.H.R., A.C.R., X.O.), Little Rock, Arkansas
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Smajlagić D, Kvarme Jacobsen K, Myrum C, Haavik J, Johansson S, Zayats T. Moderating effect of mode of delivery on the genetics of intelligence: Explorative genome-wide analyses in ALSPAC. Brain Behav 2018; 8:e01144. [PMID: 30378284 PMCID: PMC6305932 DOI: 10.1002/brb3.1144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Intelligence is a core construct of individual differences in cognitive abilities and a strong predictor of important life outcomes. Within recent years, rates of cesarean section have substantially increased globally, though little is known about its effect on neurodevelopmental trajectories. Thus, we aimed to investigate the influence of delivery by cesarean section on the genetics of intelligence in children. METHODS Participants were recruited through the Avon Longitudinal Study of Parents and Children (ALSPAC). Intelligence was measured by the Wechsler Intelligence Scale for Children (WISC). Genotyping was performed using the Illumina Human Hap 550 quad genome-wide SNP genotyping platform and was followed by imputation using MACH software. Genome-wide interaction analyses were conducted using linear regression. RESULTS A total of 2,421 children and 2,141,747 SNPs were subjected to the genome-wide interaction analyses. No variant reached genome-wide significance. The strongest interaction was observed at rs17800861 in the GRIN2A gene (β = -3.43, 95% CI = -4.74 to -2.12, p = 2.98E-07). This variant is predicted to be located within active chromatin compartments in the hippocampus and may influence binding of the NF-kappaB transcription factor. CONCLUSIONS Our results may indicate that mode of delivery might have a moderating effect on genetic disposition of intelligence in children. Studies of considerable sizes (>10,000) are likely required to more robustly detect variants governing such interaction. In summary, the presented findings prompt the need for further studies aimed at increasing our understanding of effects various modes of delivery may have on health outcomes in children.
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Affiliation(s)
- Dinka Smajlagić
- Department of Clinical Science, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
- Center for Medical Genetics and Molecular MedicineHaukeland University HospitalBergenNorway
| | - Kaya Kvarme Jacobsen
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Craig Myrum
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Jan Haavik
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Stefan Johansson
- Department of Clinical Science, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
- Center for Medical Genetics and Molecular MedicineHaukeland University HospitalBergenNorway
| | - Tetyana Zayats
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
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Uncoupling Protein 2 Inhibition Exacerbates Glucose Fluctuation-Mediated Neuronal Effects. Neurotox Res 2017; 33:388-401. [PMID: 28875237 DOI: 10.1007/s12640-017-9805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 01/10/2023]
Abstract
Though glucose fluctuations have been considered as an adverse factor for the development of several diabetes-related complications, their impact in the central nervous system is still not fully elucidated. This study was conducted to evaluate the responses of neuronal cells to different glycemic exposures alongside to elucidate the role of uncoupling protein 2 (UCP2) in regulating such responses. To achieve our goals, primary cortical neurons were submitted to constant high (HG)/low (LG) or glucose level variations (GVs), and the pharmacological inhibition of UCP2 activity was performed using genipin. Results obtained show that GV decreased neuronal cells' viability, mitochondrial membrane potential, and manganese superoxide dismutase activity and increased reactive oxygen species (ROS) production. GV also caused an increase in the glutathione/glutathione disulfide ratio and in the protein expression levels of nuclear factor E2-related factor 2 (NRF2), UCP2, NADH-ubiquinone oxidoreductase chain 1 (ND1), and mitochondrially encoded cytochrome c oxidase I (MTCO1), both mitochondrial DNA encoded subunits of the electron transport chain. Contrariwise, genipin abrogated all those compensations and increased the levels of caspase 3-like activity, potentiated mitochondrial ROS levels, and the loss of neuronal synaptic integrity, decreased the protein expression levels of NRF1, and increased the protein expression levels of UCP5. Further, in the control and LG conditions, genipin increased mitochondrial ROS and the protein expression levels of UCP4, postsynaptic density protein 95 (PSD95), ND1, and MTCO1. Overall, these observations suggest that UCP2 is in the core of neuronal cell protection and/or adaptation against GV-mediated effects and that other isoforms of neuronal UCPs can be upregulated to compensate the inhibition of UCP2 activity.
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