Birth by Caesarean Section and Educational Achievement in Adolescents

Contributor:

A/P Seng Chua:

Obstetrician and Gynaecologist

VMO: Westmead, Westmead Private and Norwest Private

Founder and Chair of Westmead Women's Institute of Research and Data Collaboration

Article:

BIRTH AND LONGER TERM OUTCOMES: CS AND EDUCATIONAL ACHIEVEMENTS IN ADOLESCENTS. (December 2021). Slykerman RF, Li E, Shackleton N, Milne BJ. ANZJOG 2021;61(3):386 (New Zealand).

Relevance:

With a steadily increasing caesarean section (CS) rate, there has been concerns regarding the lack of exposure to maternal vaginal flora on the infant's central nervous system, potentially affecting cognitive outcome later in life. Initial studies in UK (retrospective) suggested that school children delivered by CS (esp less than 39 weeks) are in the lower quartile in cognitive performance compared to their peers borne via vaginal route.

This study:

This is a population-based study from NZ that linked birth data of over 110,000 Children to other records including socioeconomic, health and educational records. One major outcome measure included university admittance and endorsements in excellence and merit (NCEA).

Conclusion:

“Although it may still impact gut microbiota, in this NZ study, mode of birth was not associated with any change in secondary school educational achievement”.

Interesting point from the results:

NCEA percentiles were slightly lower for CS v VB -0.37 (-0.69 - -0.06)

Sig NCEA percentiles adjusted for sibling effects 0.40 (-0.24 to 1.03) NS

The fixed-effect sibling analysis examined NCEA percentile outcomes for the 12,000 mothers who had ˃ 1 child delivered by different modes of birth (CS and VB). With this sibling analysis adjustment, NCEA percentile difference was then lost.

Comments: This shows the difficulty of dissecting nurture effect versus nature.