Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort

BACKGROUND AND OBJECTIVES: Concerns have been raised about associations between cesarean delivery and childhood obesity and asthma. However, published studies have not examined the long-term neurodevelopmental outcomes or fully addressed confounding influences. We used data from the LSAC (Longitudinal Study of Australian Children) to explore the relationship between cesarean delivery and physical and socio-emotional outcomes from 0 to 7 years, taking into account confounding factors.

METHODS: Data were from 5 waves of LSAC representing 5107 children born in 2003 and 2004. Outcome measures included: global health, asthma, BMI, use of prescribed medication, general development, medical conditions and/or disabilities, special health care needs, and socio-emotional development. Models adjusted for birth factors, social vulnerability, maternal BMI, and breastfeeding.

RESULTS: Children born by cesarean delivery were more likely to have a medical condition at 2 to 3 years (odds ratio: 1.33; P = .03), use prescribed medication at 6 to 7 years (odds ratio: 1.26; P = .04), and have a higher BMI at 8 to 9 years (coefficient: 0.08; P = .05), although this last effect was mediated by maternal obesity. Parent-reported quality of life for children born by cesarean delivery was lower at 8 to 9 years (coefficient: –0.08; P = .03) but not at younger ages. Contrasting this finding, cesarean delivery was associated with better parent-reported global health at 2 to 3 years (odds ratio: 1.23; P = .05) and prosocial skills at age 6 to 7 years (coefficient: 0.09; P = .02).

CONCLUSIONS: Cesarean delivery was associated with a mix of positive and negative outcomes across early childhood, but overall there were few associations, and these were not consistent across the 5 waves. This study does not support a strong association between cesarean delivery and poorer health or neurodevelopmental outcomes in childhood.