The association between caesarean section and cognitive ability in childhood

Social Psychiatry and Psychiatric Epidemiology volume 55, pages1231–1240(2020)Cite this article

Abstract

Purpose

Global rates of caesarean section (CS) rates have increased rapidly in recent years. This is a growing public health concern as it has been proposed that CS may impact cognitive outcomes in childhood. However, the evidence for this association is limited and inconsistent. Therefore, the aim of this study was to investigate the relationship between obstetric mode of delivery and longitudinal cognitive outcomes in childhood.

Methods

We examined this question using data from a longitudinal cohort study of 8845 participants from the Millennium Cohort Study, a nationally representative UK cohort, who completed a range of verbal and visual-spatial cognitive assessments at ages 3, 5, 7 and 11 years.

Results

We found a statistically significant association between planned CS and visual-spatial cognitive delay in the pattern construction assessment at age 5 (OR 1.31, 95% CI 0.99–1.72) and age 7 (OR 1.42, 95% CI 1.12–1.81). Additionally planned CS was also associated with increased odds of “early childhood delay” (OR 1.70, 95% CI 1.15–2.50) and borderline increased odds of “persistent delay” (OR 1.37, 95% CI 0.99–1.89) in visual-spatial cognitive tests. Mode of delivery was not associated with verbal ability or with patterns of delay at any age point in verbal cognitive tests.

Conclusion

We have reported a small association between planned CS and visual-spatial cognitive delay in childhood. However, while this result should be interpreted with caution, it highlights the need to further explore this potential relationship and the causal basis of such an association.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

References

  1. 1.

    Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep 30:1–31

    Google Scholar 

  2. 2.

    Boerma T, Ronsmans C, Melesse DY et al (2018) Global epidemiology of use of and disparities in caesarean sections. Lancet 392(10155):1341–1348

    Article  Google Scholar 

  3. 3.

    WHO (2019) European health for all database (HFA-DB): WHO Regional Office for Europe; 2019. https://gateway.euro.who.int/en/hfa-explorer/. Accessed 18 Apr 2019

  4. 4.

    Sandall J, Tribe RM, Avery L et al (2018) Short-term and long-term effects of caesarean section on the health of women and children. Lancet 392(10155):1349–1357

    Article  Google Scholar 

  5. 5.

    Kulas T, Bursac D, Zegarac Z et al (2013) New views on cesarean section, its possible complications and long-term consequences for children’s health. Med Arch 67(6):460

    Article  Google Scholar 

  6. 6.

    Lawlor DA, Najman JM, Batty GD et al (2006) Early life predictors of childhood intelligence: findings from the Mater-University study of pregnancy and its outcomes. Paediatr Perinat Epidemiol 20(2):148–162

    Article  Google Scholar 

  7. 7.

    Fitzpatrick A, Carter J, Quigley MA (2016) Association of gestational age with verbal ability and spatial working memory at age 11. Pediatrics 138(6):e20160578

    Article  Google Scholar 

  8. 8.

    Poulsen G, Wolke D, Kurinczuk JJ, Boyle EM, Field D, Alfirevic Z, Quigley MA (2013) Gestational age and cognitive ability in early childhood: a population-based cohort study. Paediatr Perinat Epidemiol 27(4):371–379

    Article  Google Scholar 

  9. 9.

    Quigley MA, Poulsen G, Boyle E, Wolke D, Field D, Alfirevic Z, Kurinczuk JJ (2012) Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Arch Dis Child Fetal Neonatal Ed 97(3):F167–F173

    Article  Google Scholar 

  10. 10.

    Curran EA, Kenny LC, Dalman C et al (2017) Birth by caesarean section and school performance in Swedish adolescents—a population-based study. BMC Pregnancy Childbirth 17(1):121

    Article  Google Scholar 

  11. 11.

    Polidano C, Zhu A, Bornstein JC (2017) The relation between cesarean birth and child cognitive development. Sci Rep 7(1):11483

    Article  Google Scholar 

  12. 12.

    Khadem N, Khadivzadeh T (2010) The intelligence quotient of school aged children delivered by cesarean section and vaginal delivery. Iran J Nurs Midwifery Res 15(3):135

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Li H-t, Ye R-w, Pei L-j et al (2011) Cesarean delivery on maternal request and childhood intelligence: a cohort study. Chin Med J 124(23):3982–3987

    PubMed  Google Scholar 

  14. 14.

    Connelly R, Platt L (2014) Cohort profile: UK millennium Cohort study (MCS). Int J Epidemiol 43(6):1719–1725

    Article  Google Scholar 

  15. 15.

    Plewis I, Calderwood L, Hawkes D et al (2007) Millennium cohort study: technical report on sampling. Centre for Longitudinal Study, London

    Google Scholar 

  16. 16.

    Hansen K (2014) Millennium Cohort Study: a guide to the datasets. Centre for Longitudinal Studies, London

    Google Scholar 

  17. 17.

    Castillo-Ruiz A, Mosley M, Jacobs AJ et al (2018) Birth delivery mode alters perinatal cell death in the mouse brain. Proc Natl Acad Sci USA 115(46):11826–11831

    CAS  Article  Google Scholar 

  18. 18.

    Borre YE, O’Keeffe GW, Clarke G et al (2014) Microbiota and neurodevelopmental windows: implications for brain disorders. Trends Mol Med 20(9):509–518

    Article  Google Scholar 

  19. 19.

    Wampach L, Heintz-Buschart A, Fritz JV et al (2018) Birth mode is associated with earliest strain-conferred gut microbiome functions and immunostimulatory potential. Nat Commun 9(1):5091

    Article  Google Scholar 

  20. 20.

    Gao W, Salzwedel AP, Carlson AL et al (2019) Gut microbiome and brain functional connectivity in infants—a preliminary study focusing on the amygdala. Psychopharmacology 236(5):1641–1651

    CAS  Article  Google Scholar 

  21. 21.

    Christian LM, Galley JD, Hade EM et al (2015) Gut microbiome composition is associated with temperament during early childhood. Brain Behav Immun 45:118–127

    Article  Google Scholar 

  22. 22.

    Quigley M, Hockley C, Davidson L (2007) Agreement between hospital records and maternal recall of mode of delivery: evidence from 12 391 deliveries in the UK Millennium Cohort Study. BJOG 114(2):195–200

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

  1. School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland

    Michael Hanrahan & Ali S. Khashan

  2. The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland

    Fergus P. McCarthy & Ali S. Khashan

  3. Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland

    Fergus P. McCarthy

  4. Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland

    Gerard W. O’Keeffe

Authors
  1. Michael Hanrahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fergus P. McCarthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerard W. O’Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali S. Khashan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali S. Khashan.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 480 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hanrahan, M., McCarthy, F.P., O’Keeffe, G.W. et al. The association between caesarean section and cognitive ability in childhood. Soc Psychiatry Psychiatr Epidemiol 55, 1231–1240 (2020). https://doi.org/10.1007/s00127-019-01798-4

Download citation

Keywords

  • Caesarean section
  • Obstetric mode of delivery
  • Cognitive ability