Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology
Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
Int J Epidemiol. 2016 Apr;45(2):532-42. doi: 10.1093/ije/dyw001. Epub 2016 Apr 10.
It has been suggested that birth by caesarean section (CS) may affect psychological development through changes in microbiota or stress response. We assessed the impact of mode of delivery, specifically CS, on the development of attention-deficit/hyperactivity disorder (ADHD), using a large, population-based cohort.
The study cohort consisted of all singleton live births in Sweden from 1990 to 2008 using data from Swedish national registers. Mode of delivery included: unassisted vaginal delivery(VD), assisted VD, elective CS or emergency CS. ADHD was determined using International Classification of Diseases version 10 (F90 or F98.8), or prescription for ADHD medication. We used Cox regression to assess the association between birth by CS and ADHD in the total study population, adjusting for perinatal and sociodemographic factors, then stratified Cox regression analysis on maternal identification number to assess the association among siblings.
Our cohort consisted of 1 722 548 children, and among these 47 778 cases of ADHD. The hazard ratio (HR) of the association between elective CS, compared with unassisted VD, and ADHD was 1.15 [95% confidence interval (CI): 1.11-1.20] in the cohort, and 1.05 (95% CI: 0.93-1.18) in the stratified analysis. The HR of the association between emergency CS and ADHD was 1.16 (95% CI: 1.12-1.20])in the cohort and 1.13 (95% CI: 1.01-1.26) in the stratified analysis.
Birth by CS is associated with a small increased risk of ADHD. However among siblings the association only remained for emergency CS. If this were a causal effect by CS, the association would be expected to persist for both types of CS, suggesting the observed association is due to confounding.
有人提出，剖宫产（CS）可能会通过改变微生物群或应激反应来影响心理发育。我们使用大型人群队列评估了分娩方式，特别是 CS，对注意力缺陷多动障碍（ADHD）发展的影响。
本研究队列包括 1990 年至 2008 年瑞典所有单胎活产儿的数据，来源于瑞典国家登记处。分娩方式包括：无辅助阴道分娩（VD）、辅助 VD、择期 CS 或紧急 CS。ADHD 通过使用国际疾病分类第 10 版（F90 或 F98.8）或 ADHD 药物处方确定。我们使用 Cox 回归评估 CS 分娩与总研究人群中 ADHD 之间的关联，调整围产期和社会人口因素，然后对母亲识别号进行分层 Cox 回归分析，以评估兄弟姐妹之间的关联。
我们的队列包括 1 722 548 名儿童，其中 ADHD 病例 47 778 例。与无辅助 VD 相比，择期 CS 与 ADHD 之间的关联风险比（HR）为 1.15（95%置信区间[CI]：1.11-1.20），分层分析为 1.05（95% CI：0.93-1.18）。紧急 CS 与 ADHD 之间的关联 HR 为 1.16（95% CI：1.12-1.20）），分层分析为 1.13（95% CI：1.01-1.26）。
CS 分娩与 ADHD 的风险略有增加相关。然而，在兄弟姐妹中，这种关联仅在紧急 CS 中仍然存在。如果这是 CS 引起的因果效应，则预计这种关联将持续存在于两种类型的 CS 中，这表明观察到的关联是由于混杂因素造成的。
