Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age

Andrew Massa; Zhixin Yang; Ryan Tamashiro; Oliver Isik; Ruth Landau; Caleb H Miles; Britta S Von Ungern-Sternberg; Andrew Whitehouse; Guohua Li; Craig E Pennell; Caleb Ing

doi:10.1515/jpm-2024-0188

Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age

J Perinat Med. 2024 Oct 10. doi: 10.1515/jpm-2024-0188. Online ahead of print.

Authors

Andrew Massa¹, Zhixin Yang¹, Ryan Tamashiro¹, Oliver Isik¹, Ruth Landau¹, Caleb H Miles², Britta S Von Ungern-Sternberg^{3

4

5}, Andrew Whitehouse⁶, Guohua Li^{1

7}, Craig E Pennell⁸, Caleb Ing^{1

7}

Affiliations

¹ Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
² Department of Biostatistics, Mailman School of Public Health, New York, NY, USA.
³ Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia.
⁴ Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia.
⁵ Team Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia.
⁶ Kids Research Institute Australia, University of Western Australia, Perth, Australia.
⁷ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
⁸ Department of Obstetrics and Gynaecology, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.

PMID: 39378319
DOI: 10.1515/jpm-2024-0188

Abstract

Objectives: Previous studies have reported that mode of delivery, particularly cesarean delivery (CD), is associated with neurodevelopmental outcomes in children. This study evaluates behavioral and neuropsychological test scores in children based on mode of delivery.

Methods: Children enrolled in the Raine Study from Western Australia, born between 1989 and 1992 by instrumental vaginal delivery (IVD), elective CD, and non-elective CD, were compared to those with spontaneous vaginal delivery (SVD). The primary outcome was the Child Behavior Checklist (CBCL) administered at age 10. Secondary outcomes included evaluations of language, motor function, cognition, and autistic traits. Multivariable linear regression was used to evaluate score differences by mode of delivery adjusted for sociodemographic and clinical characteristics, and Poisson regression was used to evaluate for increased risk of clinical deficit.

Results: Of 2,855 children, 1770 (62.0 %) were delivered via SVD, 480 (16.8 %) via IVD, 346 (12.1 %) via elective CD, and 259 (9.1 %) via non-elective CD. Non-elective CD was associated with higher (worse) CBCL Internalizing (+2.09; 95 % CI 0.49, 3.96; p=0.01) scores, and elective CD was associated with lower (worse) McCarron Assessment of Neuromuscular Development (MAND) (-3.48; 95 % CI -5.61, -1.35; p=0.001) scores. Differences were not seen in other outcomes, and increased risk of clinical deficit was not observed with either the CBCL Internalizing or MAND scores.

Conclusions: Differences in behavior and motor function were observed in children delivered by CD, but given that score differences were not associated with increased incidence of clinical deficit, clinical significance may be limited.

Keywords: behavioral deficit; cesarean delivery; mode of delivery; neurodevelopment.