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Type: Journal article
Title: Implications of caesarean section for children's school achievement: a population-based study
Author: Smithers, L.
Mol, B.
Wilkinson, C.
Lynch, J.
Citation: Australian and New Zealand Journal of Obstetrics and Gynaecology, 2016; 56(4):374-380
Publisher: Wiley
Issue Date: 2016
ISSN: 0004-8666
Statement of
Lisa G. Smithers, Ben W. Mol, Chris Wilkinson and John W. Lynch
Abstract: Background: Caesarean birth is one of the most frequently performed major obstetrical interventions. Although there is speculation that caesarean at term may have consequences for children’s later health and development, longer-term studies are needed. Aim: We aimed to evaluate risks to poor school achievement among children born by caesarean section compared with spontaneous vaginal birth. Materials and Methods: This population-based observational study involved linkage of routinely collected perinatal data with children’s school assessments. Perinatal data included all children born in South Australia from 1999 to 2005. Participants were children born by elective caesarean (exposed, n = 650) or vaginal birth (unexposed, n = 2959), to women who previously had a caesarean delivery. School assessments were reported via a standardised national assessment program for children attending grade three (at ~eight years of age). Assessments included reading, writing, spelling, grammar and numeracy and were categorised according to performing at above or ≤National Minimum Standards (NMS). Statistical analyses involved augmented inverse probability weighting (apiw) and accounted for a range of maternal, perinatal and sociodemographic characteristics. Results: Children performing ≤NMS for vaginal birth versus caesarean section were as follows: reading 144/640 (23%) and 688/2921 (24%), writing 69/636(11%) and 351/2917 (12%), spelling 128/646 (20%) and 684/2937 (23%), grammar 132/646 (20%) and 655/2937 (22%), and numeracy 151/634 (24%) and 729/2922 (25%). Both the raw data and the aipw analyses suggested little differences in school achievement between children born by caesarean versus vaginal birth. Conclusion: Analyses that carefully controlled for a wide range of confounders suggest that caesarean section does not increase the risk of poor school outcomes at age eight.
Keywords: caesarean section; child development; education; record linkage; vaginal birth
Rights: © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
DOI: 10.1111/ajo.12475
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