Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijng 100191, China.
Chin Med J (Engl). 2011 Dec;124(23):3982-7.
Cesarean section births have been steadily increasing over the past decade and have become an epidemic in China. Cesarean delivery on maternal request is a major contributor to this upward trend, and there has been of much concern about its impact on maternal and child health. Most of mothers believe that cesarean delivery on maternal request can improve the child's intelligence, but direct evidence is sparse. In this cohort study, we aimed to directly assess the impact of cesarean delivery on maternal request on childhood intelligence.
Intelligence quotient (IQ) of 4144 preschool children from 21 cities/counties of Zhejiang and Jiangsu province whose mothers were registered in a population-based perinatal surveillance program during 1993-1996 was assessed with Chinese Wechsler Young Children Scale of Intelligence (C-WYCSI) in 2000. The outcomes were full-scale IQ, verbal IQ, and performance IQ of C-WYCSI. Mode of delivery and covariates were obtained from the surveillance program. We estimated unadjusted and adjusted effects of cesarean delivery on maternal request and assisted vaginal delivery on IQ scores compared with spontaneous vaginal delivery using regression analysis.
The mean full-scale, verbal, and performance IQ for all children was 99.3 ± 16.1, 93.6 ± 17.7, and 105.3 ± 14.3. In crude analysis, cesarean delivery on maternal request versus spontaneous vaginal delivery was associated with an increase of 3.9 (95% confidence interval, 0.6 to 7.2) points in full-scale IQ, 4.8 (1.2 to 8.4) points in verbal IQ, and 2.4 (-0.6 to 5.3) points in performance IQ. After adjusting for maternal education, occupation, and IQ, the advantage was reduced to 1.6 (-1.3 to 4.5), 2.3 (-0.8 to 5.5), and 0.6 (-2.0 to 3.3) points for full-scale, verbal, and performance IQ, respectively. Assisted vaginal delivery versus spontaneous vaginal delivery was not associated with IQ scores in any analysis.
Neither cesarean delivery on maternal request nor assisted vaginal delivery affected children's IQ.
在过去的十年中，剖宫产分娩的数量稳步增加，在中国已成为一种流行趋势。产妇要求的剖宫产是导致这一上升趋势的主要原因之一，人们对其对母婴健康的影响一直存在很大的担忧。大多数母亲认为产妇要求的剖宫产可以提高孩子的智力，但直接证据很少。在这项队列研究中，我们旨在直接评估产妇要求的剖宫产对儿童智力的影响。
1993 年至 1996 年，在浙江省和江苏省 21 个市/县进行的一项基于人群的围产儿监测项目中，登记了产妇的信息，2000 年使用中国韦氏幼儿智力量表（C-WYCSI）评估了 4144 名学龄前儿童的智商。结果为 C-WYCSI 的总智商、言语智商和操作智商。分娩方式和协变量从监测项目中获得。我们使用回归分析估计了未经调整和调整后的产妇要求的剖宫产和辅助阴道分娩与自然阴道分娩相比对智商得分的影响。
所有儿童的平均总智商、言语智商和操作智商分别为 99.3 ± 16.1、93.6 ± 17.7 和 105.3 ± 14.3。在粗分析中，与自然阴道分娩相比，产妇要求的剖宫产与总智商增加 3.9（95%置信区间，0.6 至 7.2）分、言语智商增加 4.8（1.2 至 8.4）分和操作智商增加 2.4（-0.6 至 5.3）分相关。在校正母亲教育、职业和智商后，优势分别降至 1.6（-1.3 至 4.5）分、2.3（-0.8 至 5.5）分和 0.6（-2.0 至 3.3）分，总智商、言语智商和操作智商。在任何分析中，辅助阴道分娩与自然阴道分娩均与智商评分无关。
产妇要求的剖宫产或辅助阴道分娩均不会影响儿童的智商。
