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Grisbrook MA, Dewey D, Cuthbert C, McDonald S, Ntanda H, Letourneau N. The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression? Behav Sci (Basel) 2024; 14:61. [PMID: 38247713 PMCID: PMC10813011 DOI: 10.3390/bs14010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Cesarean sections (C-sections) account for up to 21% of births worldwide. Studies have linked delivery via C-section with an increased risk of child behavior problems, such as internalizing and externalizing behaviors. Maternal postpartum depression (PPD) is also linked to child behavioral problems and may play a mediating role in the association between the mode of delivery and child behavior. Mixed findings between mode of delivery and PPD may be due to a failure to distinguish between C-section types, as unplanned/emergency C-sections are linked to post-traumatic stress disorder (PTSD), which has been linked to PPD. The objectives of this study were to determine whether, (1) compared with spontaneous vaginal delivery (SVD) and planned C-section, unplanned/emergency C-sections are associated with increased child behavior problems at two to three years of age and (2) maternal PTSD and PPD mediate the association between delivery type and child behavior problems. A secondary data analysis was conducted on 938 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Conditional process modeling was employed. Child behavior was assessed using the Child Behavior Checklist (CBCL) 1.5-5 years, and maternal PPD and PTSD were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ), respectively. No associations were found between delivery type and child behaviors; however, the indirect effect of emergency C-section on child behaviors was significant via the mediating pathway of maternal PTSD on PPD symptoms.
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Affiliation(s)
- Marie-Andrée Grisbrook
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Henry Ntanda
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Jean Simon D, Jean-Baptiste S, Nazaire R, Joseph G, Carmil JA, Joseph F, Kondo Tokpovi VC. Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey. Trop Med Health 2023; 51:21. [PMID: 37069696 PMCID: PMC10108480 DOI: 10.1186/s41182-023-00513-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.
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Affiliation(s)
- David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Roodjmie Nazaire
- Université d'Etat d'Haïti (UEH), Faculté de Médecine et de Pharmacie (FMP), Port-au-Prince, Haiti
| | - Ghislaine Joseph
- Centre de Recherche Cultures Arts Sociétés (CELAT), University of Laval, Quebec City, Canada
| | | | - Fanor Joseph
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
- University of Antananarivo, Doctoral School of Social and Human Sciences, Antananarivo, Madagascar
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Walędziak M, Różańska-Walędziak A. Does Obesity Influence Women's Decision Making about the Mode of Delivery? J Clin Med 2022; 11:jcm11237234. [PMID: 36498808 PMCID: PMC9740825 DOI: 10.3390/jcm11237234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode of delivery and their opinion about shared decision making (SDM). Material and method: The study was designed as an online survey, filled in by 1040 women. The questionnaire included questions about women’s preferences for the mode of delivery, their opinions about CDMR and the process of decision making regarding the mode of delivery. Results: There were no statistically significant differences found between women with a BMI ≤ 25 kg/m2 and >25 kg/m2, nor with a BMI ≤ 30 kg/m2 and >30 kg/m2, on the subject of the preferred method of delivery, and the opinion regarding SDM and CDMR without medical indications. More than 85% of women in all groups, who preferred CD as the mode of delivery, wanted to have CDMR. Conclusion: We have not found obesity and overweight to be a factor influencing women’s preferred mode of delivery, their opinion about SDM and their preference for CDMR without medical indications. However, the sample size of women with morbid obesity with a BMI ≥ 35 kg/m2 was too small for the results to be considered significant in this group, and it will therefore be subject to further studies.
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Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
- Correspondence:
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Basedow LA, Kuitunen-Paul S, Roessner V, Moll GH, Golub Y, Eichler A. Are perinatal measures associated with adolescent mental health? A retrospective exploration with original data from psychiatric cohorts. BMC Psychiatry 2022; 22:668. [PMID: 36307756 PMCID: PMC9617431 DOI: 10.1186/s12888-022-04302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Perinatal markers of prenatal development are associated with offspring psychiatric symptoms. However, there is little research investigating the specificity of perinatal markers for the development of specific disorders. This study aimed to explore if perinatal markers are specifically associated with adolescent substance use disorder (SUDs). METHODS Adolescent participants from two study centers, one for SUD patients (n = 196) and one for general psychopathology (n = 307), were recruited for participation. Since the SUD participants presented with a number of comorbid disorders, we performed a 1-on-1 matching procedure, based on age, gender, and specific pattern of comorbid disorders. This procedure resulted in n = 51 participants from each group. From all participants and their mothers we recorded perinatal markers (mode of birth, weeks of completed pregnancy, birth weight, Apgar score after 5 min) as well as intelligence quotient (IQ). The SUD sample additionally filled out the Youth Safe Report (YSR) as well as the PQ-16 and the DUDIT. We aimed to distinguish the two groups (SUD sample vs. general psychiatric sample) based on the perinatal variables via a logistic regression analysis. Additionally, linear regressions were performed for the total group and the subgroups to assess the relationship between perinatal variables and IQ, YSR, DUDIT and PQ-16. RESULTS The perinatal variables were not able to predict group membership (X2 [4] = 4.77, p = .312, Cox & Snell R² = 0.053). Odds ratios indicated a small increase in probability to belonging to the general psychiatric sample instead of the SUD sample if birth was completed via C-section. After Bonferroni-correction, the linear regression models showed no relation between perinatal markers and IQ (p = .60, R² = 0.068), YSR (p = .09, R² = 0.121), DUDIT (p = .65, R² = 0.020), and PQ-16 (p = .73, R² =0.021). CONCLUSION Perinatal markers were not able to distinguish SUD patients from patients with diverse psychopathologies. This pattern contradicts previous findings, perhaps because our chosen markers reflect general processes instead of specific mechanistic explanations. Future studies should take care to investigate specific prenatal markers and associate them with psychopathology on the symptom level.
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Affiliation(s)
- Lukas A. Basedow
- grid.4488.00000 0001 2111 7257Faculty of Medicine, Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ,grid.10253.350000 0004 1936 9756Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Sören Kuitunen-Paul
- grid.4488.00000 0001 2111 7257Faculty of Medicine, Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ,grid.6810.f0000 0001 2294 5505Chair for Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Chemnitz, Germany
| | - Veit Roessner
- grid.4488.00000 0001 2111 7257Faculty of Medicine, Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Gunther H. Moll
- grid.5330.50000 0001 2107 3311Department of Child and Adolescent Mental Health, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Yulia Golub
- grid.4488.00000 0001 2111 7257Faculty of Medicine, Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anna Eichler
- grid.5330.50000 0001 2107 3311Department of Child and Adolescent Mental Health, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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Dachew BA, Tessema GA, Alati R. Association between obstetric mode of delivery and emotional and behavioural problems in children and adolescents: the children of the 90s health study. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02374-z. [PMID: 36239743 DOI: 10.1007/s00127-022-02374-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Existing evidence on the relationship between mode of delivery and offspring emotional and behavioural problems, especially in older age groups, is limited and inconsistent. This study aimed to examine the association between obstetric mode of delivery and emotional and behavioural problems in offspring aged 3-16 years. METHODS The sample for this study comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom. The study cohort ranged from 7074 (at 3 years of age) to 4071 (at 16 years of age) mother-offspring pairs. Data on obstetric mode of delivery were abstracted from obstetric records by trained research midwives and classified as spontaneous vaginal delivery, assisted vaginal delivery and caesarean delivery (elective and emergency). Offspring emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ) when the child was 3, 7, 9, 11, and 16 years. Logistic regression analyses were used to examine associations. RESULTS Assisted vaginal delivery was associated with an increased risk of emotional problems at age 11 years (OR = 1.42; 95% CI 1.11-1.81). No significant associations were observed at ages 3, 7, 9 and 16. We found no evidence of associations between caesarean delivery (elective or emergency) and emotional and behavioural measures in offspring across all age groups. CONCLUSION Mode of delivery does not appear to be associated with emotional and behavioural problems in children and adolescents. Further research is needed to understand the potential longer-term effects of assisted vaginal deliveries on offspring emotional development.
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Affiliation(s)
| | - Gizachew A Tessema
- School of Population Health, Curtin University, Perth, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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Si KY, Li HT, Zhou YB, Li ZW, Zhang L, Zhang YL, Ye RW, Liu JM. Cesarean delivery on maternal request and common child health outcomes: A prospective cohort study in China. J Glob Health 2022; 12:11001. [PMID: 35265334 PMCID: PMC8878985 DOI: 10.7189/jogh.12.11001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Cesarean delivery vs vaginal delivery was reported to increase the risks of childhood obesity, pneumonia, anemia, and neurobehavioral disorders, but few studies were able to deal with the confounding biases associated with medical conditions indicating cesareans. This prospective cohort study aims to investigate the associations of non-medically indicated cesarean delivery on maternal request (CDMR) with these child health outcomes. Methods Among 17 748 liveborn infants whose mothers (primiparas) participated in a randomized controlled trial on micronutrient supplementation and pregnancy outcomes during 2006-2009 in 5 rural counties in Hebei Province, China, 6972 singletons born by full-term spontaneous vaginal delivery (SVD) and 3626 by CDMR were extracted for the assessments of obesity (weight-for-height z-score >3) and pneumonia (self-reported) at 1.5-5 years in 2011. Some children were further randomly selected from these two groups for the assessments of anemia (hemoglobin <110 g/L, 2341 SVD and 2417 CDMR) and neurobehavioral disorders (raw score of Child Behavior Checklist larger than the 90th percentile of the normative sample, 1257 SVD and 1060 CDMR). Results Compared with SVD, CDMR was associated with increased risks of obesity (adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.14-1.75, P = 0.002) and anemia (aOR = 1.65, 95% CI = 1.28-2.12, P < 0.001), but not with the risk of pneumonia (aOR = 1.16, 95% CI = 0.94-1.45, P = 0.17) or neurobehavioral disorders (aORs varied from 0.82 to 0.91, P > 0.05) in childhood. Conclusions Cesarean delivery, independent of cesarean indications, is likely associated with childhood obesity and anemia, indicating a need to keep pregnant women informed, especially those seeking CDMR, a need to explore possible improvement on obstetric service, and even a need for main stakeholders to reach a compromise in making a cesarean decision. Trial registration ClinicalTrials.gov: NCT00133744 and NCT01404416
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Affiliation(s)
- Ke-yi Si
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Hong-tian Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu-bo Zhou
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhi-wen Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Le Zhang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ya-li Zhang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Rong-wei Ye
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jian-meng Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
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Maher GM, Khashan AS, McCarthy FP. Obstetrical mode of delivery and behavioural outcomes in childhood and adolescence: findings from the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1697-1709. [PMID: 35032173 PMCID: PMC9288955 DOI: 10.1007/s00127-022-02233-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the association between mode of delivery (in particular caesarean section) and behavioural outcomes in offspring at six time-points between age 3 and 17 years. METHODS Similar to previous work examining the association between mode of delivery and behavioural outcomes in offspring at age 7, we used maternal-reported data from the Millennium Cohort Study. Data on mode of delivery were collected when children were 9 months and categorised as spontaneous vaginal delivery, assisted vaginal delivery, induced vaginal delivery, emergency caesarean section, planned caesarean section and caesarean section after induction of labor. Data on behavioural outcomes were collected at ages 3, 5, 7, 11, 14 and 17 years using the Strengths and Difficulties Questionnaire (SDQ). Crude and adjusted logistic regression examined mode of delivery-behavioural difficulties relationship, using validated SDQ cut-off points (total SDQ ≥ 17, emotional ≥ 5, conduct ≥ 4, hyperactivity ≥ 7, peer problems ≥ 4 and prosocial behaviour ≤ 4). Multilevel models with linear splines examined the association between mode of delivery and repeated measures of SDQ. RESULTS There were 18,213 singleton mother-child pairs included at baseline, 13,600 at age 3; 13,831 at age 5; 12,687 at age 7; 11,055 at age 11; 10,745 at age 14 and 8839 at age 17. Adjusted logistic regression suggested few associations between mode of delivery and behavioural outcomes at ages 3, 5, 11, 14 and 17 years using validated SDQ cut-off points. After correction for multiple testing, only the protective association between planned caesarean section-Conduct difficulties at age 5 years (OR 0.63, 95% CI 0.46, 0.85) and positive association between caesarean section after induction-Emotional difficulties at age 11 years (OR 1.57, 95% CI 1.19, 2.07) remained statistically significant. Multilevel modelling suggested mean SDQ scores were similar in each mode of delivery group at each time point. CONCLUSIONS Results of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Ali S Khashan
- INFANT Research Centre, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Takács L, Putnam SP, Bartoš F, Čepický P, Monk C. Parity moderates the effect of delivery mode on maternal ratings of infant temperament. PLoS One 2021; 16:e0255367. [PMID: 34383795 PMCID: PMC8360581 DOI: 10.1371/journal.pone.0255367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Cesarean section (CS) rates are rising rapidly around the world but no conclusive evidence has been obtained about the possible short- and long-term effects of CS on child behavior. We evaluated prospectively the association between CS and infant temperament across the first 9 postpartum months, controlling for indications for CS and investigating parity and infant sex as moderators. Methods The sample consisted of mothers and their healthy infants. Infant temperament was measured using the Infant Characteristics Questionnaire completed by the mothers at 6 weeks (n = 452) and 9 months (n = 258) postpartum. Mode of birth was classified into spontaneous vaginal birth (n = 347 for 6 weeks sample; 197 for 9 months sample), CS planned for medical reasons (n = 55; 28) and emergency CS (n = 50; 33). Results Multiple regression analysis revealed no main effects of birth mode, but showed a significant interaction between birth mode and parity indicating that emergency CS in firstborn infants was associated with more difficult temperament at 6 weeks. There were no significant associations between indications for CS and infant temperament, although breech presentation predicted difficult temperament at 9 months. Conclusion We largely failed to support the association between CS and infant temperament. Although our results suggest that emergency CS may be associated with temperament in firstborns, further research is needed to replicate this finding, preferably using observational measures to assess child temperament.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
- * E-mail:
| | - Samuel P. Putnam
- Department of Psychology, Bowdoin College, Brunswick, Maine, United States of America
| | - František Bartoš
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Pavel Čepický
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Catherine Monk
- Department of Obstetrics & Gynecology, and Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- New York State Psychiatric Institute, New York, New York, United States of America
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9
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Kenkel W. Birth signalling hormones and the developmental consequences of caesarean delivery. J Neuroendocrinol 2021; 33:e12912. [PMID: 33145818 PMCID: PMC10590550 DOI: 10.1111/jne.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
Rates of delivery by caesarean section (CS) are increasing around the globe and, although several epidemiological associations have already been observed between CS and health outcomes in later life, more are sure to be discovered as this practice continues to gain popularity. The components of vaginal delivery that protect offspring from the negative consequences of CS delivery in later life are currently unknown, although much attention to date has focused on differences in microbial colonisation. Here, we present the case that differing hormonal experiences at birth may also contribute to the neurodevelopmental consequences of CS delivery. Levels of each of the 'birth signalling hormones' (oxytocin, arginine vasopressin, epinephrine, norepinephrine and the glucocorticoids) are lower following CS compared to vaginal delivery, and there is substantial evidence for each that manipulations in early life results in long-term neurodevelopmental consequences. We draw from the research traditions of neuroendocrinology and developmental psychobiology to suggest that the perinatal period is a sensitive period, during which hormones achieve organisational effects. Furthermore, there is much to be learned from research on developmental programming by early-life stress that may inform research on CS, as a result of shared neuroendocrine mechanisms at work. We compare and contrast the effects of early-life stress with those of CS delivery and propose new avenues of research based on the links between the two bodies of literature. The research conducted to date suggests that the differences in hormone signalling seen in CS neonates may produce long-term neurodevelopmental consequences.
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Affiliation(s)
- William Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Takács L, Putnam SP, Monk C, Dahlen HG, Thornton C, Bartoš F, Topalidou A, Peters LL. Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study. Child Psychiatry Hum Dev 2021; 52:1094-1105. [PMID: 33128716 PMCID: PMC8528797 DOI: 10.1007/s10578-020-01084-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/19/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023]
Abstract
The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children's Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic. .,Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA.
| | - Samuel P. Putnam
- grid.253245.70000 0004 1936 7654Department of Psychology, Bowdoin College, Brunswick, ME USA
| | - Catherine Monk
- grid.21729.3f0000000419368729Department of Obstetrics & Gynecology, and Psychiatry, Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Hannah G. Dahlen
- grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Charlene Thornton
- grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - František Bartoš
- grid.4491.80000 0004 1937 116XDepartment of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Anastasia Topalidou
- grid.7943.90000 0001 2167 3843Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lilian L. Peters
- grid.4830.f0000 0004 0407 1981Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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11
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Hoffman KW, Lee JJ, Corcoran CM, Kimhy D, Kranz TM, Malaspina D. Considering the Microbiome in Stress-Related and Neurodevelopmental Trajectories to Schizophrenia. Front Psychiatry 2020; 11:629. [PMID: 32719625 PMCID: PMC7350783 DOI: 10.3389/fpsyt.2020.00629] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Early life adversity and prenatal stress are consistently associated with an increased risk for schizophrenia, although the exact pathogenic mechanisms linking the exposures with the disease remain elusive. Our previous view of the HPA stress axis as an elegant but simple negative feedback loop, orchestrating adaptation to stressors among the hypothalamus, pituitary, and adrenal glands, needs to be updated. Research in the last two decades shows that important bidirectional signaling between the HPA axis and intestinal mucosa modulates brain function and neurochemistry, including effects on glucocorticoid hormones and brain-derived neurotrophic factor (BDNF). The intestinal microbiome in earliest life, which is seeded by the vaginal microbiome during delivery, programs the development of the HPA axis in a critical developmental window, determining stress sensitivity and HPA function as well as immune system development. The crosstalk between the HPA and the Microbiome Gut Brain Axis (MGBA) is particularly high in the hippocampus, the most consistently disrupted neural region in persons with schizophrenia. Animal models suggest that the MGBA remains influential on behavior and physiology across developmental stages, including the perinatal window, early childhood, adolescence, and young adulthood. Understanding the role of the microbiome on critical risk related stressors may enhance or transform of understanding of the origins of schizophrenia and offer new approaches to increase resilience against stress effects for preventing and treating schizophrenia.
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Affiliation(s)
- Kevin W. Hoffman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jakleen J. Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - Thorsten M. Kranz
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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Guo L, Wang T, Wang W, Fan B, Xie B, Zhang H, Liao Y, Lu C. Association between habitual weekday sleep duration and depressive symptoms among Chinese adolescents:The role of mode of birth delivery. J Affect Disord 2020; 265:583-589. [PMID: 31759667 DOI: 10.1016/j.jad.2019.11.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Depressive symptoms among adolescents are common. This study aimed to assess, among Chinese adolescents, the associations of habitual weekday sleep duration with depressive symptoms and whether these associations varied with the mode of birth delivery. METHODS Data were from the 2015 School-based Chinese Adolescents Health Survey, and 150,053 students' questionnaires were qualified for analysis. Multi-level logistic regression models were performed. RESULTS A weekday sleep duration of ≤5 h/night was associated with depressive symptoms (adjusted odds ratio [aOR]=2.98, 95% CI=2.75-3.24), and adolescents who reported a weekday sleep duration of 5-7 h/night (aOR=1.69, 95% CI=1.60-1.79) and >9 h/night (aOR=1.28, 95% CI=1.11-1.45) were also at a higher risk of depressive symptoms. Stratification analyses showed that in both adolescents delivered by vaginal birth and cesarean section (CS), a weekday sleep duration of ≤5 h/night, 5-7 h/night, and >9 h/night were associated with the increased risk of depressive symptoms in the adjusted models, and the magnitudes of the aORs in adolescents delivered by CS were slightly higher than those in adolescents delivered by vaginal birth. LIMITATIONS The cross-sectional study design and self-reported sleep duration and depressive symptoms. CONCLUSION This study demonstrates a significant U-shaped association between weekday sleep duration and depressive symptoms among Chinese adolescents. In both adolescents delivered by vaginal birth and CS, those who reported having abnormal sleep duration were at a high risk of depressive symptoms. Based on the findings of this study, we suggest sleep duration and mode of delivery should be a matter of concern for public health authorities.
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Affiliation(s)
- Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Tian Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bo Xie
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China.
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13
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Liu J, Li Z, Ye R, Liu J, Ren A. Periconceptional folic acid supplementation and risk of parent-reported asthma in children at 4-6 years of age. ERJ Open Res 2020; 6:00250-2019. [PMID: 32280668 PMCID: PMC7132036 DOI: 10.1183/23120541.00250-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Folic acid supplementation is universally recommended for women of child-bearing age to prevent fetal neural tube defects (NTDs). Concerns have arisen over the potential risk for childhood allergy and asthma due to folic acid supplementation. We examined whether periconceptional supplementation with low-dose folic acid only was associated with an increased risk for allergy symptoms or asthma in offspring at 4-6 years of age. METHODS Out of 247 831 participating women enrolled in 1993-1996, 9090 were randomly selected and their children were followed up in 2000-2001. Information on mothers' demographic characteristics, folic acid supplementation and allergic diseases among children was collected. We used logistic regression to evaluate the association between folic acid intake and risk for allergic disease while adjusting for potential confounding factors. RESULTS The rate of allergy symptoms was 1.54% among children whose mothers had taken folic acid compared with 2.04% among those whose mothers had not taken folic acid, and the rate of asthma was 0.92% and 0.88%, respectively. Maternal folic acid supplementation was not associated with risk for allergy symptoms or asthma, with odds ratios (95% CI) of 0.80 (0.58-1.11) and 1.04 (0.67-1.61), respectively. No differences in the occurrence of allergy symptoms or asthma were observed when data were analysed by timing of supplementation or compliance with folic acid supplementation. CONCLUSIONS Supplementation with low-dose folic acid only during the periconceptional period did not increase risk for allergy symptoms or asthma in children at 4-6 years of age in a population without staple fortification with folic acid.
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Affiliation(s)
- Jufen Liu
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, PR China
- Dept of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, PR China
| | - Zhiwen Li
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, PR China
- Dept of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, PR China
| | - Rongwei Ye
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, PR China
- Dept of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, PR China
| | - Jianmeng Liu
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, PR China
- Dept of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, PR China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, PR China
- Dept of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, PR China
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14
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Shi XY, Wang J, Zhang WN, Zhao M, Ju J, Li XY, Lu Q, Wang B, Zou LP. Cesarean Section Due to Social Factors Affects Children's Psychology and Behavior: A Retrospective Cohort Study. Front Pediatr 2020; 8:586957. [PMID: 33569359 PMCID: PMC7869965 DOI: 10.3389/fped.2020.586957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/30/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Cesarean section (CS) use has reached a frequency well-above what is expected on the basis of obstetric indications. The large increase in CS use, often for non-medical indications, is of concern given the risks for both women and children. Research about the influence of CS on children's behavior is not new, but most studies didn't differentiate CS due to social factors (such as fear of labor pain, auspicious dates, etc.) from CS with medical indications. Medical indications for CS include fetal distress and intrauterine hypoxia, which may also affect the mental and physical health of the children, thus be a confounding factor. In China, a significant proportion of women undergo CS because of social factors, which provides us a good model to study whether non-fetal triggered delivery will affect children's behavior. Thus, we assessed the impact of CS due to social factors on child psychology and behavior. Methods: We conducted a retrospective cohort study. Children were divided into three groups according to delivery mode: vaginal delivery (VD), CS with medical indications, and CS due to social factors (also called as elective cesarean section, ECS). Parents or guardians were required to complete four rating scales of Chinese version [Conners' Parent Rating Scale (CPRS), Child Behavior Checklist-Parent Form (CBCL-PF), Swanson, Nolan, and Pelham rating scale-Parent Form (SNAP-IV-PF), and Behavior Rating Inventory of Executive Function-Parent Form (BRIEF-PF)] on psychological and behavioral problems regarding their children. Results: Among the 38,780 children aged 7-15 years, 29,103 (75.05%) were delivered by VD and 9,677 (24.95%) were delivered by CS (7,844 with medical indications; 1,833 by ECS). Ten covariates were found to significantly affect ECS. Four rating scales were used in this study: CPRS, CBCL-PF, SNAP-IV-PF, and BRIEF-PF. ECS affected child psychology and behavior in several aspects including inattention, hyperactivity/impulsivity, social problems, and executive dysfunction. Regarding to inattention, the ECS group had a higher SNAP-IV-PF inattention score (P = 0.03), compared with the VD group. Logistic multivariate stepwise regression analysis showed that in the ECS group, the ORs were 1.20 in the partially adjusted analyses of SNAP-IV-PF and CPRS. Regarding to social problems, ECS group had a higher CBCL-PF score for the social problems category compared with the VD group (P = 0.0001). Kruskal-Wallis rank sum tests showed that the ECS group had higher BRIEF-PF scores regarding Working Memory (P = 0.04), and Organize (P = 0.01) compared with the VD group. Conclusions: CS affected the offspring's psychology and behavior. After removing possible influence of medical indications, the effect of CS due to social factors on the offspring's psychology and behavior still exists.
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Affiliation(s)
- Xiu-Yu Shi
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei-Na Zhang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Ju
- Department of Pediatrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Li
- Department of Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Qian Lu
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bin Wang
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Ping Zou
- Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,Center for Brain Disorders Research, Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
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15
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Huang K, Yan S, Wu X, Zhu P, Tao F. Elective caesarean section on maternal request prior to 39 gestational weeks and childhood psychopathology: a birth cohort study in China. BMC Psychiatry 2019; 19:22. [PMID: 30642307 PMCID: PMC6332907 DOI: 10.1186/s12888-019-2012-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The recommendation of non-indicated caesarean section (CS) after 39 gestational weeks has been announced based on evidence of maternal and infant physiological effects. The potential psychological risks have not been acknowledged. This study aims to investigate emotional and behavioral problems in pre-school children born with elective CS (ECS) on maternal request prior to 39 weeks. METHODS Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children's emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages. RESULTS The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks. CONCLUSION Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.
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Affiliation(s)
- Kun Huang
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Shuangqin Yan
- Ma’anshan Maternal and Child Health Center, No 72 Jiashan Road, Ma’anshan, Anhui Province China
| | - Xiaoyan Wu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Peng Zhu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Fangbiao Tao
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
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16
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Liang J, Mu Y, Li X, Tang W, Wang Y, Liu Z, Huang X, Scherpbier RW, Guo S, Li M, Dai L, Deng K, Deng C, Li Q, Kang L, Zhu J, Ronsmans C. Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births. BMJ 2018; 360:k817. [PMID: 29506980 PMCID: PMC5836714 DOI: 10.1136/bmj.k817] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. DESIGN Observational study. SETTING China's National Maternal Near Miss Surveillance System (NMNMSS). PARTICIPANTS 6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016. MAIN OUTCOME MEASURES Obstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time. RESULTS Caesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government's policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time. CONCLUSIONS China is the only country that has succeeded in reverting the rising trends in caesarean sections. China's success is remarkable given that the changes in obstetric risk associated with the relaxation of the one child policy would have led to an increase in the need for caesarean sections. China's experience suggests that change is possible when strategies are comprehensive and deal with the system level factors that underpin overuse as well as the various incentives at work during a clinical encounter.
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Affiliation(s)
- Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen Tang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaona Huang
- Health, Nutrition and Water, Sanitation & Hygiene, UNICEF China, Beijing, China
| | - Robert W Scherpbier
- Health, Nutrition and Water, Sanitation & Hygiene, UNICEF China, Beijing, China
| | - Sufang Guo
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Dai
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changfei Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Carine Ronsmans
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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17
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Leung CY, Leung GM, Schooling CM. Mode of delivery and child and adolescent psychological well-being: Evidence from Hong Kong's "Children of 1997" birth cohort. Sci Rep 2017; 7:15673. [PMID: 29142203 PMCID: PMC5688155 DOI: 10.1038/s41598-017-15810-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022] Open
Abstract
Mode of delivery (vaginal or cesarean section) is thought to affect gut microbiota, which in turn may affect psychological well-being. As such, mode of delivery is potentially a modifiable factor for psychological well-being. Here we examined the association of mode of delivery with child and adolescent psychological well-being. We used multivariable linear regression in a population-representative Hong Kong Chinese birth cohort, “Children of 1997,” to examine the adjusted associations of mode of delivery with behavioral problems assessed from parent-reported Rutter score at ~7 (n = 6294) and ~11 years (n = 5598), self-esteem assessed from self-reported Culture-Free Self-Esteem Inventory score at ~11 years (n = 6937) and depressive symptoms assessed from self-reported Patient Health Questionnaire-9 score at ~13 years (n = 5797). Cesarean Section (CS) was associated with children born in private hospitals, boys, and firstborns, higher maternal body mass index, higher maternal age, preeclampsia, higher socioeconomic position (SEP) and maternal birth in Hong Kong. CS was unrelated to behavior, self-esteem and depressive symptoms adjusted for infant characteristics (sex, gestational age, birthweight, parity and breast feeding), maternal characteristics (mother’s age and place of birth) and SEP. In a developed non-Western setting, mode of delivery was not clearly associated with childhood or early adolescent psychological well-being.
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Affiliation(s)
- Cherry Y Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Department of Community Health Systems, School of Nursing, UCSF, San Francisco, California, USA
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, People's Republic of China. .,CUNY School of Public Health and Health Policy, New York, USA.
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18
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Rutayisire E, Wu X, Huang K, Tao S, Chen Y, Tao F. Childhood emotional and behavior problems and their associations with cesarean delivery. ACTA ACUST UNITED AC 2017; 40:145-153. [PMID: 28977068 PMCID: PMC6900761 DOI: 10.1590/1516-4446-2016-2152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 05/08/2017] [Indexed: 01/15/2023]
Abstract
Objective: To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery. Methods: Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children’s emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations. Results: A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95%CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95%CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95%CI 0.98-1.29), peer problems (OR 1.11; 95%CI 0.99-1.24), hyperactivity (OR 1.02; 95%CI 0.91-1.15), or emotional problems (OR 1.06; 95%CI 0.90-1.24). Conclusion: In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations.
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Affiliation(s)
- Erigene Rutayisire
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Xiaoyan Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Shuman Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Yunxiao Chen
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
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Hu LQ, Flood P, Li Y, Tao W, Zhao P, Xia Y, Pian-Smith MC, Stellaccio FS, Ouanes JPP, Hu F, Wong CA. No Pain Labor & Delivery: A Global Health Initiative's Impact on Clinical Outcomes in China. Anesth Analg 2017; 122:1931-8. [PMID: 27195636 DOI: 10.1213/ane.0000000000001328] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The availability of labor analgesia is highly variable in the People's Republic of China. There are widespread misconceptions, by both parturients and health care providers, that labor epidural analgesia is harmful to mother and baby. Meanwhile, China has one of the highest cesarean delivery rates in the world, exceeding 50%. The goal of the nongovernmental No Pain Labor & Delivery (NPLD) is to facilitate sustainable increases in vaginal delivery rates by increasing access to safe neuraxial labor analgesia, thereby decreasing the cesarean delivery rate. NPLD was launched in 2008 with the stated goal of improving labor outcome in China by increasing the absolute labor epidural analgesia rate by 10%. NPLD established 10 training centers over a 10-year period. We hypothesized that increased availability of labor analgesia would result in reduced requests for cesarean delivery and better labor outcomes for mother and baby. Multidisciplinary teams of Western clinicians and support staff traveled to China for 8 to 10 days once a year. The approach involved establishing 24/7 obstetric anesthesia coverage in Chinese hospitals through education and modeling multidisciplinary approaches, including problem-based learning discussions, bedside teaching, daily debriefings, simulation training drills, and weekend conferences. As of November 2015, NPLD has engaged with 31 hospitals. At 24 of these sites, 24/7 obstetric anesthesia coverage has been established and labor epidural analgesia rates have exceeded 50%. Lower rates of cesarean delivery, episiotomy, postpartum blood transfusion, and better neonatal outcomes were documented in 3 impact studies comprising approximately 55,000 deliveries. Changes in practice guidelines, medical policy, and billing codes have been implemented in conjunction with the modernization of perinatal practice that has occurred concurrently in China since the first NPLD trip in 2008.
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Affiliation(s)
- Ling-Qun Hu
- From the *Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; †Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, California; ‡Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center at Harvard Medical School, Boston, Massachusetts; §Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas; ‖Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts; ¶Department of Anesthesiology, Ohio State University, Wexner Medical Center, Columbus, Ohio; #Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital at Harvard Medical School, Boston, Massachusetts; **Department of Anesthesiology, Stony Brook University, Stony Brook, New York; ††Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; ‡‡Amherst College, Amherst, Massachusetts; and §§Department of Anesthesia, University of Iowa, Iowa City, Iowa
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Rogers GB, Keating DJ, Young RL, Wong ML, Licinio J, Wesselingh S. From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry 2016; 21:738-48. [PMID: 27090305 PMCID: PMC4879184 DOI: 10.1038/mp.2016.50] [Citation(s) in RCA: 588] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/06/2023]
Abstract
The human body hosts an enormous abundance and diversity of microbes, which perform a range of essential and beneficial functions. Our appreciation of the importance of these microbial communities to many aspects of human physiology has grown dramatically in recent years. We know, for example, that animals raised in a germ-free environment exhibit substantially altered immune and metabolic function, while the disruption of commensal microbiota in humans is associated with the development of a growing number of diseases. Evidence is now emerging that, through interactions with the gut-brain axis, the bidirectional communication system between the central nervous system and the gastrointestinal tract, the gut microbiome can also influence neural development, cognition and behaviour, with recent evidence that changes in behaviour alter gut microbiota composition, while modifications of the microbiome can induce depressive-like behaviours. Although an association between enteropathy and certain psychiatric conditions has long been recognized, it now appears that gut microbes represent direct mediators of psychopathology. Here, we examine roles of gut microbiome in shaping brain development and neurological function, and the mechanisms by which it can contribute to mental illness. Further, we discuss how the insight provided by this new and exciting field of research can inform care and provide a basis for the design of novel, microbiota-targeted, therapies.
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Affiliation(s)
- G B Rogers
- South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - D J Keating
- South Australian Health and Medical Research Institute, Centre for Neuroscience and Department of Human Physiology, Flinders University, Adelaide, SA, Australia
| | - R L Young
- South Australian Health and Medical Research Institute, Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - M-L Wong
- South Australian Health and Medical Research Institute, Mind and Brain Theme, and Flinders University, Adelaide, SA, Australia
| | - J Licinio
- South Australian Health and Medical Research Institute, Mind and Brain Theme, and Flinders University, Adelaide, SA, Australia
| | - S Wesselingh
- South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, SA, Australia
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The impact of obstetric mode of delivery on childhood behavior. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1557-67. [PMID: 25868660 DOI: 10.1007/s00127-015-1055-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 03/23/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates. METHODS Families with infants born between December 2007 and May 2008 (N = 11,134) were randomly selected and recruited to the Growing Up in Ireland study. Mode of delivery was classified into spontaneous vaginal delivery; instrumental vaginal delivery; emergency Cesarean section (CS); and elective CS. The 'Ages and Stages Questionnaire' was completed at age 9-months and the 'Strengths and Difficulties Questionnaire' at 3 years. Data were weighted to represent the national sample (N = 73,662) and multivariate logistic regression was used for the statistical analyses. RESULTS At age 9 months, elective CS was associated with a delay in personal social skills [adjusted odds ratio, aOR 1.24; (95% confidence interval, CI 1.04, 1.48)] and gross motor function [aOR 1.62, (95% CI 1.34, 1.96)], whereas emergency CS was associated with delayed gross motor function [aOR 1.30, (95% CI 1.06, 1.59)]. At age 3 years there was no significantly increased risk of an abnormal total SDQ score across all modes of delivery. CONCLUSIONS Children born by elective CS may face a delay in cognitive and motor development at age 9 months. No increase in total SDQ score was found across all modes of delivery. Further investigation is needed to replicate these findings in other populations and explore the potential biological mechanisms.
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Obstetrical Mode of Delivery and Childhood Behavior and Psychological Development in a British Cohort. J Autism Dev Disord 2015; 46:603-14. [DOI: 10.1007/s10803-015-2616-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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González-Valenzuela MJ, López-Montiel D, González-Mesa ES. Exposure to synthetic oxytocin during delivery and its effect on psychomotor development. Dev Psychobiol 2015; 57:908-20. [PMID: 26011378 DOI: 10.1002/dev.21321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/12/2015] [Indexed: 01/02/2023]
Abstract
The main objective is to examine the influence of oxytocin administration during delivery on psychomotor development at age five years. This was a retrospective cohort study involving two groups: children of mothers exposed vs. not exposed to oxytocin during labor. Of the 7,465 newborns registered in our maternity service during 2006 we randomly selected an initial sample of 400 children. Of these, 146 children were assessed using the motor scale of the Battelle Developmental Inventory. Other predictor variables that could potentially act as confounders and/or interact with the main relationship were also examined. The data were subjected to bivariate analysis, estimates of measures of strength of association, stratified analysis and multivariate binary logistic regression. The results indicate that exposure to synthetic oxytocin during delivery is an independent risk factor for a delay in gross and fine motor development. This was the case after controlling for the variables duration of labor and sex of the newborn, none of which modified the effect of oxytocin on gross and fine motor development. However, sex of the newborn were shown to be confounding gross motor development. In light of these results, and with the aim of preventing possible psychomotor alterations, further studies are now needed to analyze the effect that the oxytocin dose and the duration of perfusion may have on children's subsequent development.
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Affiliation(s)
- María-José González-Valenzuela
- Dpto Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Málaga, Campus Universitario de Teatinos, s/n Málaga, 29071, Spain.
| | - Dolores López-Montiel
- Dpto Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga Campus Universitario de Teatinos, s/n Málaga, 29071, Spain
| | - Ernesto Santiago González-Mesa
- Dpto Cirugía, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Málaga, Campus Universitario de Teatinos, s/n Málaga, 29071, Spain
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Feng XL, Wang Y, An L, Ronsmans C. Cesarean section in the People's Republic of China: current perspectives. Int J Womens Health 2014; 6:59-74. [PMID: 24470775 PMCID: PMC3891566 DOI: 10.2147/ijwh.s41410] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People's Republic of China. METHODS Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. FINDINGS Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People's Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People's Republic of China. There was a lively debate on whether women's preferences or providers' distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People's Republic of China's health development approach - focusing on specialized care and marginalizing primary care - that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus. CONCLUSION The overuse of cesareans is rising alarmingly in the People's Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part, though further research is warranted to understand the mechanisms. Knowledge of the consequences of cesareans, particularly for women, is limited in the People's Republic of China, leaving a substantial literature gap.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Ying Wang
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Lin An
- Department of Women, Children and Adolescent Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
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Kelmanson IA. Emotional and behavioural features of preschool children born by Caesarean deliveries at maternal request. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2013. [DOI: 10.1080/17405629.2013.787024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Huang C, Martorell R, Ren A, Li Z. Cognition and behavioural development in early childhood: the role of birth weight and postnatal growth. Int J Epidemiol 2013; 42:160-71. [PMID: 23243117 PMCID: PMC3600622 DOI: 10.1093/ije/dys207] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We evaluate the relative importance of birth weight and postnatal growth for cognition and behavioural development in 8389 Chinese children, 4-7 years of age. Method Weight was the only size measure available at birth. Weight, height, head circumference and intelligence quotient (IQ) were measured between 4 and 7 years of age. Z-scores of birth weight and postnatal conditional weight gain to 4-7 years, as well as height and head circumference at 4-7 years of age, were the exposure variables. Z-scores of weight at 4-7 years were regressed on birth weight Z-scores, and the residual was used as the measure of postnatal conditional weight gain. The outcomes were child's IQ, measured by the Chinese Wechsler Young Children Scale of Intelligence, as well as internalizing behavioural problems, externalizing behavioural problems and other behavioural problems, evaluated by the Child Behavior Checklist 4-18. Multivariate regressions were conducted to investigate the relationship of birth weight and postnatal growth variables with the outcomes, separately for preterm children and term children. RESULTS Both birth weight and postnatal weight gain were associated with IQ among term children; 1 unit increment in Z-score of birth weight (∼450 g) was associated with an increase of 1.60 [Confidence interval (CI): 1.18-2.02; P < 0.001] points in IQ, and 1 unit increment in conditional postnatal weight was associated with an increase of 0.46 (CI: 0.06-0.86; P = 0.02) points in IQ, after adjustment for confounders; similar patterns were observed when Z-scores of postnatal height and head circumference at age 4-7 years were used as alternative measurements of postnatal growth. Effect sizes of relationships with IQ were smaller than 0.1 of a standard deviation in all cases. Neither birth weight nor postnatal growth indicators were associated with behavioural outcomes among term children. In preterm children, neither birth weight nor postnatal growth measures were associated with IQ or behavioural outcomes. CONCLUSIONS Both birth weight and postnatal growth were associated with IQ but not behavioural outcomes for Chinese term children aged 4-7 years, but the effect sizes were small. No relation between either birth weight or postnatal growth and cognition or behavioural outcomes was observed among preterm children aged 4-7 years.
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Affiliation(s)
- Cheng Huang
- Department of Global Health, George Washington University, Washington DC, WA 20037, USA.
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