Review finds association between cesarean delivery and autism, ADHD

Cesarean deliveries are associated with increased rates of autism spectrum disorder and attention deficit hyperactivity disorder, but it's not currently clear why. (Pixelistanbul/Getty)

A systematic review found a significant association between cesarean deliveries and certain developmental and psychiatric disorders in children. 

Published in JAMA Network Open, the review ultimately identified 61 studies comprising more than 20 million births. It demonstrated a statistically higher incidence of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) among children experiencing C-section delivery compared to those born via vaginal delivery.

Children delivered by C-section were 33% more likely to develop ASD and 17% more likely to develop ADHD.

While the study provides a stronger sense of the strength of the association between C-section births and mental disorders, study author Tianyang Zhan cautions the data don't prove C-section deliveries cause these disorders. Without further research to establish a mechanism that produces ASD and/or ADHD, it’s difficult to draw any concrete conclusions as to the relative risks involved in different modes of delivery.

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“Since we cannot provide evidence that c-sections cause mental problems in children, we cannot draw conclusions that healthy women should absolutely avoid C-sections. However, it is well recognized by the international healthcare community that there is no evidence showing that C-section deliveries are beneficial for healthy women,” Zhan told FierceHealthcare.

However, it does offer evidence of another reason pregnant women should take a measured look as they make decisions about their delivery preferences, according to Zhan. “Women should be informed of the potential risks and benefits for themselves, their babies, and subsequent pregnancies before they make a decision, especially in countries where culture preferences and financial factors play important roles,” she said.

The review points out that C-section deliveries have not been associated with benefits to children, either.

Prior research has associated C-section deliveries with physical ailments such as obesity, asthma, Type 1 diabetes, allergies and acute lymphoblastic leukemia. According to this review, previous research has theorized that deliveries performed prior to the onset of labor might provide a potential explanation.

The review does not note a significant difference between deliveries categorized as elective C-sections compared to those categorized as emergencies. The authors speculate that the absence of a specific definition of an elective procedure might have influenced the results and suggest future studies take a more careful approach to winnowing one category from the other.

RELATED: About 1 in 40 kids has autism spectrum disorder

Zhan noted there is a general consensus in the healthcare community that C-section deliveries are overused in some areas and underused in others.

Getting a better handle on the reasons for elective C-sections, particularly in areas where they appear to be overused, would help illuminate the underlying factors in these increases and generate a better basis for balancing the potential risks to children against the potential benefits to mothers giving birth via C-section.

“Our study does not provide irrefutable proof that C-sections cause neurodevelopmental disorders, therefore we cannot weigh the potential benefits and the potential risk of ADHD/ASD,” Zhan said.