既往剖宫产术后分娩方式计划与儿童特殊教育需求：基于人群的记录链接队列研究。
Planned mode of birth after previous caesarean section and special educational needs in childhood: a population-based record linkage cohort study.
机构信息
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
出版信息
BJOG. 2021 Dec;128(13):2158-2168. doi: 10.1111/1471-0528.16828. Epub 2021 Jul 28.
OBJECTIVE
To investigate the association between planned mode of birth after previous caesarean section and a child's risk of having a record of special educational needs (SENs).
DESIGN
Population-based cohort study.
SETTING
Scotland.
POPULATION
A cohort of 44 892 singleton children born at term in Scotland between 2002 and 2011 to women with one or more previous caesarean sections.
METHODS
Linkage of Scottish national health and education data sets.
MAIN OUTCOME MEASURES
Any SENs and specific types of SEN recorded when a child was aged 4-11 years and attending a Scottish primary or special school.
RESULTS
Children born following planned vaginal birth after previous caesarean (VBAC) compared with elective repeat caesarean section (ERCS) had a similar risk of having a record of any SENs (19.24 versus 17.63%, adjusted risk ratio aRR 1.04, 95% CI 0.99-1.09) or specific types of SEN. There was also little evidence that planned VBAC with or without labour induction compared with ERCS was associated with a child's risk of having a record of any SENs (21.42 versus 17.63%, aRR 1.09, 95% CI 1.01-1.17 and 18.78 versus 17.63%, aRR 1.03, 95% CI 0.98-1.08, respectively) or most types of SEN. However, an increased risk of sensory impairment was seen for planned VBAC with labour induction compared with ERCS (1.18 versus 0.78%, risk difference 0.4%, adjusted odds ratio aOR 1.60, 95% CI 1.09-2.34).
CONCLUSIONS
This study provides little evidence of an association between planned mode of birth after previous caesarean and SENs in childhood beyond a small absolute increased risk of sensory impairment seen for planned VBAC with labour induction. This finding may be the result of performing multiple comparisons or residual confounding. The findings provide valuable information to manage and counsel women with previous caesarean section concerning their future birth choices.
TWEETABLE ABSTRACT
There is little evidence planned mode of birth after previous caesarean section is associated with special educational needs in childhood.
目的
研究既往剖宫产术后计划分娩方式与儿童特殊教育需求（SEN）记录之间的关联。
设计
基于人群的队列研究。
设置
苏格兰。
人群
2002 年至 2011 年间，在苏格兰足月分娩的 44892 名单胎儿童，母亲曾有过一次或多次剖宫产史。
方法
苏格兰国家卫生和教育数据集的链接。
主要观察指标
4-11 岁儿童在苏格兰小学或特殊学校就读时记录的任何 SEN 及特定类型的 SEN。
结果
与选择性重复剖宫产（ERCS）相比，经阴道分娩（VBAC）后计划分娩的儿童有相似的 SEN 记录风险（19.24%比 17.63%，调整风险比 aRR 1.04，95%CI 0.99-1.09）或特定类型的 SEN。也没有证据表明，与 ERCS 相比，有或没有引产的计划 VBAC 与儿童 SEN 记录风险相关（21.42%比 17.63%，aRR 1.09，95%CI 1.01-1.17 和 18.78%比 17.63%，aRR 1.03，95%CI 0.98-1.08）或大多数类型的 SEN。然而，与 ERCS 相比，计划 VBAC 伴引产与感觉障碍风险增加相关（1.18%比 0.78%，风险差异 0.4%，调整比值比 aOR 1.60，95%CI 1.09-2.34）。
结论
本研究未发现既往剖宫产术后计划分娩方式与儿童期 SEN 之间存在关联，仅发现计划 VBAC 伴引产时感觉障碍风险略有增加。这一发现可能是由于进行了多次比较或存在残余混杂因素。这些发现为管理和咨询有剖宫产史的妇女提供了有价值的信息，以帮助其选择未来的分娩方式。
推文摘要
既往剖宫产术后计划分娩方式与儿童期特殊教育需求之间关联的证据很少。
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