C- Section May Raise Attention Deficit Risk in Neonates

Scott A. Adler, Ph.D. Associate Professor Coordinator Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research Visual and Cognitive Development Project York University Toronto, Ontario CanadaMedicalResearch.com Interview with:
Scott A. Adler, Ph.D
Associate Professor Coordinator
Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research
Visual and Cognitive Development Project
York University
Toronto, Ontario Canada


Medical Research: What is the background for this study?

Dr. Adler: Experiences that we have early in life clearly have an impact on our brain development and behavior as we get older.  Numerous studies have detailed these experiences, ranging from how we were fed as a baby to how many languages we hear to traumatic events.  These experiences have been shown to influence formation, maintenance, and pruning of the networks of synaptic connections in our brain’s that impact all manner of thought and behavior.  Yet, the impact of one of the earliest experiences, that of being born, on brain and psychological behavior has not before been explored.  A recent study with rat pups has strongly suggested that the birth process has a definite impact on initial brain development.  If that is the case, what happens if the infant’s birth is one in which she does not experience the natural birth process, such as occurs with caesarean section births?

Medical Research: What are the main findings?

Dr. Adler: There were two main findings from this study.  We measured the speed and timing of infants’ saccadic eye movements, which are overt indicators of attention, relative to the onset of visual events on a computer monitor.  Moving attention and eye movements can occur through two general classes of processes.  The first is bottom-up mechanisms in which attention is moved reactively and automatically to the appearance or existence of unique and salient events in the world.  In this case, where attention goes is essentially controlled by the events in the world.

The second is top-down mechanisms in which we move attention voluntarily to what we determine to be relevant event in the world based on our own cognitive biases and goals.

This study found that 3-month-old infants born by caesarean section were significantly slower to move attention and make eye movements in reaction to the occurrence of visual events on the basis of bottom-up mechanisms than were infants born vaginally.  In contrast, there was difference between infants in moving attention and making eye movements in anticipation of the appearance of visual events on the basis of top-down mechanisms.  Additionally, maternal age, which has been shown to be related to the occurrence of caesarean sections, was found not to be related to the current effects.

Medical Research: What should clinicians and patients take away from your report?

Dr. Adler: First, I urge caution at taking too much away from this study as it is only one study, does not indicate any causal link but only a relation between caesarean section and attentional slowness, and it needs to be replicated.  Further, there are many other factors, such method of feeding, fetal birth weight, use of epidurals (just to name a few), that could be influencing the current results.  For clinicians, however, who are astutely aware of the rising rates of caesarean section births, the current finding should be added to their list of considerations when advising patients on the risks of caesarean section births.  Clearly, emergency c-sections and c-sections for high risk pregnancies, such as with high birth weight babies and older mothers, the current result likely should not have much impact.  However, for low-risk pregnancies and elective c-sections, which are the fastest growing category of c-sections, the current finding will add to the chorus of cautions concerning this category of c-sections.  In fact, many medical associations in the U.S., Canada, and the U.K. have issued warning concerning the use of c-sections for low-risk pregnancies and in an elective manner.  For patients, especially those with low-risk pregnancies and those considering an elective c-section, the information provided by this study could help influence their decision as to whether to have a c-section.  They would know that perhaps the procedure is not completely innocuous and could potentially have an impact on their child’s brain and cognition.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Adler: Because this is just the first study detailing any brain or psychological impact of c-sections, there is a long list of studies that need to follow this one.  Beyond looking at all the other variables that likely contribute to the result of this study, such as feeding method, type of pregnancy, administration of drugs during delivery, there are 3 important avenues to follow up. First, many developmental effects that show up in infancy dissipate as the child ages.  So, does this attentional slowness in c-section delivered infants modulate as they get older.  In other words, is this a temporary difference or does being delivered by c-section have a more permanent repercussions.  Second, and this related to the first, many of issues with learning in academic settings have been linked to problems with allocating attention.  This is true for ADD/ADHD, Autistic Spectrum Disorders, as well as many learning disabilities.  Whether there is any relation between being born by c-section, and the potentially related attention issue, and these learning problems is completely unknown.  In the future, we will need to investigate whether there is in fact a link, especially if being born by c-section is having influence on initial brain development.  Finally, we were unable to separate out emergency c-sections from elective c-sections.  In many emergency c-sections, the infant experiences partial labor, in which case they receive part of the birth experience — is that enough? Would experiencing part of the birth experience ameliorate the effect on attention and be sufficient for initializing the relevant brain development?  Future research must answer this question in order for the effect uncovered in this study to have more medical usefulness.


Differential attentional responding in caesarean versus vaginally delivered infants

Scott A. Adler1 & Audrey M. B. Wong-Kee-You
Atten Percept Psychophys
DOI 10.3758/s13414-015-0969-3

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Scott A. Adler, Ph.D (2015). C- Section May Raise Attention Deficit Risk in Neonates MedicalResearch.com

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