Implications of caesarean section for children's school achievement: A population-based study.
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.


OBJECTIVE
We aimed to evaluate risks to poor school achievement among children born by caesarean section compared with spontaneous vaginal birth.


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.


CONCLUSIONS
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.
School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.|The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
Lisa G
LG
Smithers
The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
Ben W
BW
Mol
Maternal Fetal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Chris
C
Wilkinson
School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.|The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.|School of Social & Community Medicine, University of Bristol, England, UK.
John W
JW
Lynch
D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D002648:Child; D004522:Educational Status; D017558:Elective Surgical Procedures / Q000523:psychology; D005260:Female; D006801:Humans; D007746:Labor Presentation; D008297:Male; D008433:Mathematics; D036801:Parturition / Q000523:psychology; D011247:Pregnancy; D011932:Reading; D012307:Risk Factors; D016064:Vaginal Birth after Cesarean / Q000523:psychology*; D014956:Writing; D055815:Young Adult
caesarean section; child development; education; record linkage; vaginal birth