A recent analysis suggests that children who are born by cesarean delivery may be more likely to develop autism or attention deficit disorders, but medical professionals caution that more nuanced research still needs to be done to explore the association.
For the meta-analysis that was published by JAMA Network Open in August 2019, researchers reviewed data from more than 60 studies that involved more than 20 million births in 19 countries. They found that C-sections were associated with approximately a 33% higher chance of an autism spectrum disorder and 17% higher odds of ADHD diagnosis when compared to vaginal births. They did not find a significant link to other disorders.
Still, medical experts — including the study’s authors — have been careful to say that correlation doesn’t equal causation. Here’s what else you need to know about the potential association of C-sections and autism or ADHD.
Potential Flaws With The Report
While it may be alarming to hear that C-sections can be linked to autism and ADHD, medical experts who were not associated with the meta-analysis caution there are some significant shortcomings.
In reaction to the study, Peter Baghurst, an associate professor of health sciences at the University of Adelaide, points out that preterm birth is strongly associated with autism. The link found in the study could simply be present because preterm births often demand cesarean sections.
Associate Professor Jason Howitt, research director for the School of Health Sciences at Swinburne University in Australia, thinks the correlation is flawed given that several of the studies used for the analysis had higher than average rates of autism.
Beyond that, autism involves a complex interaction between genes and the environment, explains Dr. Nina Carroll, an OB-GYN who consults with Your Doctors Online.
“Consequently, there are many potential risk factors,” Carroll says. “As of 2019, scientists agree on these: Advanced maternal or paternal age, exposure to toxic chemicals, gestational diabetes, and use of a certain type of antidepressants called SSRIs.”
It’s possible taking folate and fatty acids during pregnancy could reduce the risk of autism, Carroll says. A 2013 study published in the Journal of The American Medical Association found that folic acid supplements early in pregnancy may reduce the risk of autism by 40%.
Do C-Sections Cause Long-Term Health Problems?
Looking at the potential long-term problems associated with C-sections is important, researchers say, as more women in the United States are delivering babies this way.
In the United States, 32% of births are C-sections, which is up from 23% in 2000, according to the Centers for Disease Control and Prevention. The World Health Organization considers the ideal cesarean rate to be between 10% and 15%.
While a C-section can be a life-saving measure necessary during a complicated pregnancy or delivery, the delivery method has been linked to long-term health problems affecting both mother and child and has been the subject of several studies. The results have been somewhat convoluted, however.
For instance, one study found that women who had C-sections had hysterectomy complications later in life. Several studies have suggested that babies born via C-section are at a higher risk to become obese than those who were born vaginally, but a later analysis found that the mode of birth doesn’t actually affect body mass index in children. Still, another study found C-sections may be correlated with food allergies in infants.
Some C-sections, like those in an emergency situation, may be unavoidable. But Consumer Reports recommends researching a hospital’s C-section rates, as some are known to have much higher rates than others. You can simply ask your provider about the hospital’s C-section rates or consult a third-party ratings system, since many hospitals do not make this kind of information readily available.
Consumer Reports also suggests having a conversation with your doctor and letting him or her know if you prefer a vaginal delivery. If you would like to avoid a C-section unless absolutely necessary, you can communicate this as part of a delivery plan.
As we learn more about the links between birth procedures and the health of children, we can apply the knowledge in ways that benefit future generations. The research continues!