caesarean section, delivery

Caesarean Sections Linked to Higher Risk of Autism and ADHD Interview with:
Tianyang Zhang, MSc
Centre for Psychiatry Research, Department of Clinical Neuroscience
Stockholm Health Care Services, Stockholm County Council
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
Stockholm, Sweden What is the background for this study?

Response: We know that births by caesarean delivery are linked to several negative health outcomes in the children, such as obesity, asthma, allergy, and type 1 diabetes. However, the association between c-section and neurodevelopmental and psychiatric disorders has been less studied. In addition, it is unclear whether the extent of this association is different if a caesarean section is performed planned in advance or urgently due to medical reasons during a delivery. What are the main findings?

Response: In this systematic review and meta-analysis of 61 studies comprising over 20 million deliveries, birth by caesarean section (both planned and urgent) was associated with higher risk of autism spectrum disorders and attention-deficit/hyperactivity disorder (ADHD). Importantly, however, the precise reasons for this association are unclear and further research on this topic is needed. What should readers take away from your report?

Response: There is no doubt that caesarean section is a life-saving surgical procedure when medically indicated. Our study synthesized data from published literature and found a potential link between caesarean delivery and neurodevelopmental and psychiatric disorders in the offspring. However, importantly, our findings cannot prove that caesarean delivery causes these disorders. Rather, our findings highlight the importance of understanding the reasons behind these links. What recommendations do you have for future research as a result of this work? 

Response: Further research is required to explain the observed associations between caesarean delivery and neurodevelopmental and psychiatric disorders in the offspring by using research designs that take into account other variables that may explain this association.

Disclosures: TZ acknowledges financial support from China Scholarship Council. LS-C and AV-P are supported by fellowships from the Alicia Koplowitz Foundation. ZC is supported by the Swedish Research Council (grant number 2018-02213). HL has served as a speaker for Evolan and Shire and has received research grants from Shire. DMC and LFC receive royalties for contributing articles to UpToDate, Wolters Kluwer Health. LFC is supported by a Junior Researcher grant from the Swedish Research Council for Health, Working Life and Welfare (FORTE grant number 2015-00569). The other authors report no financial relationships with commercial interests.


Zhang T, Sidorchuk A, Sevilla-Cermeño L, et al. Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis. JAMA Netw Open.Published online August 28, 20192(8):e1910236. doi:10.1001/jamanetworkopen.2019.10236 


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Last Updated on August 30, 2019 by Marie Benz MD FAAD