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C-section birth linked to autism, ADHD

Tianyang Zhang

Offspring born via cesarean delivery were at increased risk for autism spectrum disorder and ADHD compared with those born by vaginal delivery, findings published in JAMA Network Open revealed.

“We know that births by cesarean delivery are linked to several negative health outcomes in children, such as obesity, asthma, allergy and type 1 diabetes,” Tianyang Zhang, MSc, PhD student, Karolinska Institutet’s Child and Adolescent Psychiatry Research Center, Stockholm, told Healio Psychiatry. “However, the association between c-section and neurodevelopmental and psychiatric disorders has been less studied. In addition, it is unclear whether the extent of this association is different if a cesarean section is performed planned in advance or urgently due to medical reasons during a delivery.”

For their systematic review and meta-analysis, Zhang and colleagues searched online clinical databases for observational studies that evaluated the association between cesarean delivery and neurodevelopmental and psychiatric disorders in offspring compared with vaginal delivery. They performed random-effects meta-analyses to pool the risk for each outcome as well as sensitivity and influence analyses to test the robustness of the results.

Overall, 61 studies comprising 20,607,935 deliveries were included in the analyses.

Zhang and colleagues found that offspring born by cesarean delivery were at increased risk for autism spectrum disorders (OR = 1.33; 95% CI, 1.25-1.41; I² = 69.5%) and ADHD (OR = 1.17; 95% CI, 1.07-1.26; I² = 79.2%) compared with those born by vaginal delivery. The investigators reported no significant associations between cesarean delivery and depression/affective psychoses or nonaffective psychoses.

“I need to emphasize that our study does not provide irrefutable proof that c-sections cause neurodevelopmental disorders,” Zhang said. “Association is not causation. However, we believe that the study provides information that may help parents to be and doctors to make informed decisions about how they want their births to be.”

Although they reported similar estimates for some other neurodevelopmental and psychiatric outcomes — including intellectual disabilities, obsessive-compulsive disorders, tic disorders and eating disorders — the associations were not statistically significant, possibly due to the limited number of studies, according to the researchers.

Further analysis revealed comparable estimates for elective and emergency cesarean deliveries, both of which were tied to increased risk of ADHD and ASD in offspring, according to Zhang and colleagues.

“It is well known that c-section should ideally only be undertaken when medically necessary. Obstetricians should make every effort to provide c-section to women in need,” Zhang told Healio Psychiatry. “For women without medical indication to perform a c-section, recommending one may not be appropriate. Obstetricians should conduct a full evaluation on the status of the mother and the baby/babies to decide whether a c-section is necessary.” – by Savannah Demko

Disclosure: Zhang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.