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Cited by 119Maternal and Perinatal Health InterventionsInfant Development and Preterm CareBirth, Development, and Health

The relation between cesarean birth and child cognitive development

Open access
Polidano, Cain, Zhu, Anna, Bornstein, Joel C.·2017·Scientific Reports
DOI 10.1038/s41598-017-10831-yPMC PMC5597642
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Abstract

This is the first detailed study of the relation between cesarean birth and child cognitive development. We measure differences in child cognitive performance at 4 to 9 years of age between cesarean-born and vaginally-born children (n = 3,666) participating in the Longitudinal Study of Australian Children (LSAC). LSAC is a nationally representative birth cohort surveyed biennially. Using multivariate regression, we control for a large range of confounders related to perinatal risk factors and the socio-economic advantage associated with cesarean-born children. Across several measures, we find that cesarean-born children perform significantly below vaginally-born children, by up to a tenth of a standard deviation in national numeracy test scores at age 8–9. Estimates from a low-risk sub-sample and lower-bound analysis suggest that the relation is not spuriously related to unobserved confounding. Lower rates of breastfeeding and adverse child and maternal health outcomes that are associated with cesarean birth are found to explain less than a third of the cognitive gap, which points to the importance of other mechanisms such as disturbed gut microbiota. The findings underline the need for a precautionary approach in responding to requests for a planned cesarean when there are no apparent elevated risks from vaginal birth.

AI snapshot

Written from the paper’s full text.

TL;DR

In a nationally representative Australian birth cohort (n = 3,666), cesarean-born children scored significantly lower than vaginally-born children on several cognitive measures from ages 4–9, with differences up to about one-tenth of a standard deviation in Grade 3 numeracy. The authors argue the relation is unlikely to be fully explained by observed confounding, and that breastfeeding and adverse child/maternal health outcomes explain less than a third of the gap.

Key findings

  • Cesarean birth was negatively associated with multiple cognitive outcomes after adjustment for socio-economic and perinatal confounders: NAPLAN reading (−0.076), writing (−0.060), grammar (−0.055*), numeracy (−0.095*), problem solving at 8–9 (−0.069*), and vocabulary at 4–5 (−0.087).
  • In the low-risk privately insured sub-sample (n = 2,140), estimates were generally larger, e.g., numeracy −0.135, writing −0.131, spelling −0.132, school readiness −0.127, and vocabulary at 4–5 −0.127.
  • Mediation analysis found breastfeeding, obesity, and ADD significantly mediated the relation; total mediators accounted for 25% of the reading gap (p = 0.052) and 29% of the numeracy gap (p = 0.021), leaving at least 70% unexplained.
  • Oster lower-bound estimates were similar to the main OLS estimates for most outcomes, e.g., numeracy −0.09, suggesting results are unlikely to be entirely driven by unobserved confounding.

Methods

  • Data: Longitudinal Study of Australian Children (LSAC) B cohort, initially about 5,100 infants born March 2003–February 2004; final analytic sample n = 3,666 after attrition. About 30% were reported cesarean-born.
  • Outcomes: interviewer-administered PPVT vocabulary, Who Am I? school readiness, Matrix Reasoning problem solving, and Grade 3 NAPLAN numeracy/literacy at ages 4–9.
  • Analysis: OLS multivariate regression with over 20 socio-economic and perinatal confounders; mediation via product of coefficients; sensitivity analyses using a low-risk privately insured sub-sample and Oster lower-bound estimates.

Limitations

  • The paper states that causal relations are not established: unobserved confounding remains possible, including inheritable genetic traits such as maternal height/cephalopelvic disproportion that may affect both cesarean birth and child cognition.
  • The paper notes possible measurement error, such as caregiver under-reporting of health conditions, and that mediating effects may be biased by unobserved confounding.
  • Evident from the text: the design is observational with no randomization; cesarean birth is identified by caregiver report, though rates were comparable to national hospital statistics; and missing Grade 3 NAPLAN scores were imputed for some students.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41598-017-10831-y

Cites

49 of 49 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Lower rates of breastfeeding and adverse child and maternal health outcomes associated with cesarean birth explain less than a third of the cognitive gap.

    “Lower rates of breastfeeding and adverse child and maternal health outcomes that are associated with cesarean birth are found to explain less than a third of the cognitive gap”
    Quote in the paperSubstantial claim
  • Findingown data

    Cesarean-born children perform significantly below vaginally-born children on several cognitive measures.

    “Across several measures, we find that cesarean-born children perform significantly below vaginally-born children”
    Quote in the paperSubstantial claim
  • Findingown data

    With the exception of school readiness at 4-5 years and problem solving at 6-7 years, the Oster coefficients are much the same as the OLS regression coefficients estimated on the entire sample.

    “With the exception of school readiness at 4–5 years and problem solving at 6–7 years, the Oster coefficients are much the same as the OLS regression coefficients estimated on the entire sample.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Selection on unobserved covariates is equal to selection on observed covariates.
  • Findingown data

    Much of the estimated relations (around 70%) are found to be unrelated to lower rates of breastfeeding and adverse child and maternal health, including the diagnosis of child cognitive disorders.

    “Importantly, much of the estimated relations (around 70%) are found to be unrelated to lower rates of breastfeeding and adverse child and maternal health, including the diagnosis of child cognitive disorders.”
    Quote in the paperSubstantial claim
  • Findingown data

    We find a negative relation between cesarean birth and a range of cognitive outcomes measured from ages 4 to 9.

    “We find a negative relation between cesarean birth and a range of cognitive outcomes measured from ages 4 to 9.”
    Quote in the paperSubstantial claim
  • May combine two claims. 19
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 16

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The difference in national numeracy test scores at age 8-9 is about 0.095 standard deviations, with cesarean-born children scoring lower.

    “by up to a tenth of a standard deviation in national numeracy test scores at age 8–9”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Poor maternal general health is significantly associated with lower vocabulary at 4-5 years, but otherwise maternal health is not significantly linked to any of the cognitive measures.

    “Poor maternal general health is significantly associated with lower vocabulary at 4–5 years, but otherwise maternal health is not significantly linked to any of the cognitive measures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Descriptive statistics show that cesarean birth is associated with higher perinatal risk factors and a socio-economic advantage, especially higher maternal education, fewer older siblings, lower rates of un-partnered birth and higher rates of private health insurance.

    “In general, descriptive statistics of the control variables presented in Table 1 show that cesarean birth is associated with higher perinatal risk factors and a socio-economic advantage, especially higher maternal education, fewer older siblings, lower rates of un-partnered birth and higher rates of private health insurance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Our estimated relations persist long-term and are not confined to children with health problems.

    “Second, our estimated relations persist long-term and are not confined to children with health problems.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Cesarean birth is significantly associated with lower rates of breastfeeding and higher rates of obesity and ADD.

    “Results from the first stage of our mediating analysis suggest that cesarean birth is significantly associated with lower rates of breastfeeding and higher rates of obesity and ADD (see Table S4 of online supporting material).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Approximately 30% of primary care givers in the sample report that their children were cesarean-born.

    “In our sample, approximately 30% of primary care givers report that their children were cesarean-born (between March 2003 and February 2004).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Breastfeeding is significantly associated with higher cognitive performance, whereas ADD, ASD and obesity are significantly associated with lower levels of cognitive performance.

    “Second stage results show that breastfeeding is significantly associated with higher cognitive performance, whereas ADD, ASD and obesity are significantly associated with lower levels of cognitive performance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There are long-term compositional differences in gut microbiota by mode of birth, with differences observed up until age seven.

    “The result is long-term compositional differences in gut microbiota by mode of birth20–24, with differences observed up until age seven24.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [20] Bäckhed, F. et al. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host & Microbe 17, 690–703 (2015). source

      Not checked in the free run.

    • cites [21] Dominguez-Bello, M. et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proceedings of the Academy of Sciences 107, 11971–11975 (2010). source

      Not checked in the free run.

    • cites [22] Jakobsson, H. et al. Decreased gut microbiota diversity, de-layed bacteroidetes colonisation and reduced th1 responses in infants delivered by caesarean section. Gut 63, 559–566 (2014). source

      Not checked in the free run.

    • cites [23] Penders, J. et al. Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118, 511–521 (2006). source

      Not checked in the free run.

    • cites [24] Salminen, S., Gibson, G., McCartney, A. & Isolauri, E. Influence of mode of delivery on gut microbiota composition in seven year old children. Gut 53, 1388–1389 (2004). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cesarean sections can save lives, but rates well above the WHO recommended 15% ceiling in most developed countries suggest that many procedures are unnecessary.

    “Cesarean sections can save lives, but rates well above the World Health Organization’s recommended 15% ceiling in most developed countries suggest that many procedures are unnecessary1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Gibbons, L. et al. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report 30, 1–31 (2010).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the OECD, the rate of caesarean section increased from 14.4% of deliveries in 1990 to 25.8% in 2009.

    “In the OECD, the rate of caesarean section has increased from 14.4% of deliveries in 1990 to 25.8% in 20092”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] OECD. Health at a glance. Paris, (OECD 2011).

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    These adverse child health outcomes are associated with impaired functioning and lower academic performance.

    “that are also associated with impaired functioning and lower academic performance13, 14”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Taras, H. & Potts-Datema, W. Chronic health conditions and student performance at school. Journal of School Health 75, 255–266 (2005). source

      Not checked in the free run.

    • cites [14] Taras, H. & Potts‐Datema, W. Obesity and student performance at school. Journal of School Health 75, 291–295 (2005). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    LSAC is a nationally representative birth cohort surveyed biennially.

    “LSAC is a nationally representative birth cohort surveyed biennially.”
    • Also stated in: § Data · plain
      “LSAC is an internationally recognized and widely-used longitudinal cohort survey of child health and development33, 34.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Fiorini, M. & Keane, M. How the allocation of children’s time affects cognitive and noncognitive development. Journal of Labor Economics 32, 787–836 (2014). source

      Not checked in the free run.

    • cites [34] Bradbury, B., Corak M., Waldfogel, J. & Washbrook, E. Too many children left behind: The US achievement gap in comparative perspective, New York, (Russell Sage Foundation 2015).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cesarean birth is associated with adverse child health outcomes including asthma, type I diabetes, allergies, and obesity.

    “established links between cesarean birth and adverse child health outcomes, including asthma, type I diabetes, allergies9–11 and obesity12”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [9] Cardwell, C. et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 51, 726–735 (2008). source

      Not checked in the free run.

    • cites [10] Cho, C. E. & Norman, M. Cesarean section and development of the immune system in the off- spring. American Journal of Obstetrics and Gynecology 208, 249–254 (2013). source

      Not checked in the free run.

    • cites [11] Thavagnanam, S., Fleming, J., Bromley, A., Shields, M. & Cardwell, C. A meta-analysis of the association between caesarean section and childhood asthma. Clinical & Experimental Allergy 38, 629–633 (2008). source

      Not checked in the free run.

    • cites [12] Li, H., Zhou, Y. & Liu, J. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. International Journal of Obesity 37, 893–899 (2013). source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis includes over 20 confounders grouped into perinatal risk factors and socio-economic advantage.

    “The analysis includes over 20 confounders grouped into two main categories (Table 1): those related to perinatal risk factors and those related to the socio-economic advantage associated with cesarean-born children in Australia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Results for alternative models with different treatment of low birth weight and gestational age are much the same as those reported in Table 2.

    “Results for these alternative models are much the same as those reported in Table 2 (available upon request from the corresponding author).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A tenth of a standard deviation is similar in magnitude to the estimated relation between gender and reading in NAPLAN at age 8-9 and to effects estimated from improving teacher quality by one standard deviation and reducing average grade 3 class sizes by ten.

    “To put the size of these relations into perspective, a tenth of a standard deviation is similar in magnitude to the estimated relation between gender and reading in NAPLAN at age 8–9 (reported in Table S5a) and effects estimated from improving teacher quality by one standard deviation and reducing average grade 3 class sizes by ten50.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Rivkin, S. G. & Hanushek, E. A. & Kain. J. F. Teachers, schools, and academic achievement. Econometrica 73, 417–458 (2005). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The presence of unobserved perinatal risk factors will lead to an over-estimate of any true negative relation between cesarean birth and cognitive development, whereas the presence of unobserved socio-economic advantage will lead to an under-estimate of any negative relation.

    “The presence of the former will lead to an over-estimate of any true negative relation between cesarean birth and cognitive development; whereas the presence of the latter will lead to an under-estimate of any negative relation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Our results are consistent with results from Bentley et al.

    “Our results are consistent with results from the only previous study that we are aware of by Bentley et al.31, which found cesarean-born children had a 14% higher risk of being identified as being developmentally high risk at school starting age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These cognitive deficits in rodents can be corrected through colonization of the intestine via a fecal transplant from the control group, but only if it occurs early in life.

    “Interestingly, these cognitive deficits in rodents can be corrected through the colonization of the intestine via a fecal transplant from the control group, but only if it occurs early in life.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] Gareau, M. et al. Bacterial infection causes stress-induced memory dysfunction in mice. Gut 60, 307–17 (2010). source

      Not checked in the free run.

    • cites [29] Diamond, B., Huerta, P., Tracey, K. & Volpe, B. It takes guts to grow a brain. Bioessays 33, 588–591 (2011). source

      Not checked in the free run.

    • cites [30] Neufeld, K., Kang, N. & Bienenstock, J. Foster Reduced anxiety like behavior and central neurochemical change in germ-free mice. Neurogastroenterology & Motility 23, 255–e119 (2011). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    A possible explanation for the larger estimates in the low-risk privately insured sample is that limiting the sample to privately-insured births reduces unobserved confounding from socio-economic advantage, which in the main analysis under-states the true effects of cesarean birth.

    “A possible explanation is that by limiting the sample to privately-insured births we are reducing the unobserved confounding from the socio-economic advantage associated with cesarean-born children, which in the main analysis under-states the true effects of cesarean birth.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Restricting the sample to low-risk privately insured births reduces bias by also restricting differences in unobserved covariates.
    • Rests on an assumption: Those without private health insurance are more likely than those with private insurance to have a cesarean performed for medical reasons.

  • Classified as probably not a substantial claim.

    Interpretationown data

    By showing that only a small part of the cognitive gap is explained by mediating factors, our results leave open the possibility that direct mechanisms, such as disturbed gut microbiota, may be important.

    “By showing that only a small part of the cognitive gap is explained by mediating factors, our results leave open the possibility that direct mechanisms, such as disturbed gut microbiota, may be important.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    We cannot rule out the possibility that at least some of the residual effect is due to measurement error, for example, under-reporting of the presence of health conditions by the primary care giver, or that the mediating effects are biased by unobserved confounding.

    “However, we cannot rule-out the possibility that at least some of the residual effect is due to measurement error, for example, under-reporting of the presence of health conditions by the primary care giver, or that the mediating effects are biased by unobserved confounding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The main potential sources of unobserved confounding may be missing controls for perinatal risk factors (such as oxygen deprivation during birth) and socio-economic advantage (such as greater household income) associated with cesarean-born children.

    “The main potential sources of unobserved confounding may be missing controls for perinatal risk factors (such as oxygen deprivation during birth) and socio-economic advantage (such as greater household income) associated with cesarean-born children.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bentley et al. found that cesarean-born children had a 14% higher risk of being identified as developmentally high risk at school starting age.

    “Our results are consistent with results from the only previous study that we are aware of by Bentley et al.31, which found cesarean-born children had a 14% higher risk of being identified as being developmentally high risk at school starting age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Bentley et al. used perinatal records linked to school starting-age measures of cognition and could not examine longer-term outcomes or quantify mediating effects.

    “Bentley et al.31 used perinatal records linked to school starting-age measures of cognition and could not examine longer-term outcomes or quantify mediating effects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Potential perinatal risks not controlled for include inheritable genetic traits, such as a lack of maternal height, that may drive both cesarean birth (due to a relatively small pelvis) and child cognitive outcomes.

    “Potential perinatal risks not controlled for include inheritable genetic traits, such as a lack of maternal height, that may drive both cesarean birth (due to a relatively small pelvis (cephalopelvic disproportion))51 and child cognitive outcomes52.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] Khunpradit, S., Patumanond, J. & Tawichasri, C. Risk indicators for cesarean section due to cephalopelvic disproportion in Lamphun hospital. Journal-Medical Association of Thailand 88, S63–S68 (2005).

      Not checked in the free run.

    • cites [52] Sundet, J. M., Tambs, K., Harris, J. R., Magnus, P. & Torjussen, T. M. Resolving the genetic and environmental sources of the correlation between height and intelligence: A study of nearly 2600 Norwegian male twin pairs. Twin Research and Human Genetics 8, 307–311 (2005). source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The results are not sensitive to the inclusion of antibiotic medication as a control or other child and maternal health risks in the data.

    “However, we stress that our results are not sensitive to the inclusion of this control, or other child and maternal health risks in the data (refer to results for the ‘low-risk privately insured’ group in Table 2).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationcitation

    There is a critical window to correct any disruption to the gut microbiota, after which cognitive impacts are permanent.

    “The implication is that there is a critical window to correct any disruption to the gut microbiota, after which cognitive impacts are permanent25.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Cryan, J. F. & Dinan, T. G. Mind-altering microorganisms: the impact of the gut microbiota on brain and behavior. Nature Reviews Neuroscience 13, 701–712 (2012). source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Bentley et al. found a significant negative association between cesarean birth and several developmental domains using Australian hospital records linked to teacher-based assessments in the first year of school.

    “Using Australian hospital records linked to teacher-based assessments in the first year of school, they found a significant negative association across several developmental domains.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source

      Not checked in the free run.

29 of 29

  • The paper relies on this without support.

    The gut of cesarean-born children is seeded through contact with the mother’s skin and hospital surfaces, unlike vaginally-born children whose gut is seeded by passing through the birth canal.

    “Unlike vaginally-born children whose gut is seeded by passing through the birth canal, the gut of cesarean-born children is seeded through contact with the mother’s skin and hospital surfaces.”

  • The paper relies on this without support.

    Maternal requested cesarean birth without any medical risk factors is not covered by the public health system in Australia.

    “Important in the context of this study, maternal requested cesarean birth (without any medical risk factors) is not covered by the public health system.”

  • The paper relies on this without support.

    It is much more common for elective cesareans to occur in private hospitals under the cover of private health insurance.

    “It is much more common for elective cesareans to occur in private hospitals under the cover of private health insurance.”

  • The paper relies on this without support.

    Restricting the sample to low-risk privately insured births reduces bias by also restricting differences in unobserved covariates.

    “The idea is that by restricting the sample to those that are more similar on observed covariates, we are reducing bias by also restricting differences in unobserved covariates.”

  • The paper relies on this without support.

    Those without private health insurance are more likely than those with private insurance to have a cesarean performed for medical reasons.

    “We omitted those without private health insurance because they are more likely than those with private insurance to have a cesarean performed for medical reasons.”

  • The authors state this as an assumption.

    Selection on unobserved covariates is equal to selection on observed covariates.

    “The Oster coefficients in Table 2 represent the possible lower-bound of any relation between cesarean birth and cognitive development measures under the conservative assumption that selection on unobserved covariates is the same as selection on observed covariates.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Mode of delivery is linked with child cognitive development.

    “which fits with previous studies linking mode of delivery with child cognitive development (Polidano et al., 2017), highlighting the importance of gut microbiota colonization in cognitive development and function.”

    From The Microbiota-Gut-Brain Axis (2019) · cites this paper as Polidano et al., 2017

  • Delivery mode is linked with neurocognitive development and long-term poor immune and metabolic health outcomes.

    “Other studies have also linked delivery mode with neurocognitive development and long-term poor immune and metabolic health outcomes, highlighting the importance of microbial colonization at birth (400, 401).”

    From Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis (2023) · cites this paper as [400]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Writing mediation figures are attributed to the wrong outcome

    Minor

    The stated breastfeeding effect of 0.008 belongs to reading in Table 3; the table gives 0.003 for writing. The stated overall difference of 0.076 likewise belongs to reading in Table 2, rather than writing.

  • Standardized score differences are called percentage points

    Minor

    The 0.076 difference is reported in Table 2 in standard-deviation units, not percentage points.

  • Significant problem-solving result assigned to the wrong age

    Minor

    The text places the significant problem-solving result at age 4-5, but Table 2 places it at age 8-9.

  • Wave 5 date conflicts with children's stated age

    Minor

    Children born between March 2003 and February 2004 would be about 10-11 in 2014, not 8-9.

  • Table 1 labels standard deviations as standard errors

    Minor

    The column labeled "s.e." gives 0.498 for the proportion of female children among 1,080 cesarean births. That is consistent with a binary-variable standard deviation; the standard error of the reported proportion would be about 0.015.

5 of 5

Cites

Flagged first, then by citations

1 of the 50 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Gibbons, L. et al. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report 30, 1–31 (2010).
  2. Dunn, L. & Dunn, D. Picture Vocabulary Test (PPVT): Peabody picture vocabulary test: PPVT. 4th ed. New Jersey, (Pearson 2015).
  3. Hanushek, E. A., Schwerdt, G. Woessmann, L. and Zhang, L. General education, vocational education, and labor-market outcomes over the life-cycle, Journal of Human Resources. Advance online publication. http://hanushek.stanford.edu/sites/default/files/publications/hswz%20vocational%20final.pdf (2016).

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Related

Authors
Polidano, C., Zhu, A., & Bornstein, J. C.
Affiliations
The University of Melbourne (AU)
Corresponding author
Polidano, Cain
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2017-09-13
Volume
7
Issue
1
Pages
11483-11483
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-017-10831-y
PMC
PMC5597642
OpenAlex
W2756418520
Semantic Scholar
4f1af1d0cacf949c84e95913bb76f8c634567de5
Cited by
119
References
50
Citations by year
2026: 6 · 2025: 6 · 2024: 11 · 2023: 23 · 2022: 15 · 2021: 16 · 2020: 22 · 2019: 13 · 2018: 7
FWCI
13.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • RMIT Research Repository (RMIT University Library) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • Department of Social Services, Australian Government
  • University of Sydney
  • University of Melbourne
  • University of Queensland (CE140100027)
  • Australian Research Council (CE140100027)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
cesarean section, child cognitive development, vaginal delivery, numeracy, academic performance, breastfeeding, gut microbiota, perinatal risk factors, socioeconomic deprivation, Longitudinal Study of Australian Children
MeSH terms
Maternal Health, Academic Success, Australia, Breast Feeding, Cesarean Section, Child, Child Development, Child, Preschool, Cognition, Humans, Longitudinal Studies, Risk Factors, Socioeconomic Factors, Models, Statistical, Cohort Studies, Biomarkers, Comorbidity, Public Health Surveillance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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