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The relation between cesarean birth and child cognitive development
Open accessAbstract
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.
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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.
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22 Not checked yet · 15 Own result · 14 Own interpretation · 7 Own method · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ The relation between cesarean birth and child cognitive development > Abstract
plaincorrelationaln = 3,666- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across several measures, we find that cesarean-born children perform significantly below vaginally-born children”
§ The relation between cesarean birth and child cognitive development > Abstract
plaincorrelationaln = 3,666- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Results > Sensitivity test results
plain- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Selection on unobserved covariates is equal to selection on observed covariates.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We find a negative relation between cesarean birth and a range of cognitive outcomes measured from ages 4 to 9.”
§ The relation between cesarean birth and child cognitive development > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individually, the largest mediating effect is through reduced chances of breastfeeding, which explains 0.008 percentage points out of the 0.076 percentage point difference (or around 11%) of the gap in grade 3 NAPLAN writing scores.”
§ The relation between cesarean birth and child cognitive development > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The estimated relations using the low-risk privately insured sample are generally larger than those estimated using the entire sample.”
§ The relation between cesarean birth and child cognitive development > Results > Sensitivity test results
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The total mediating effect, generated from regressions when all of the mediators are included together, account for between 25% for reading (p = 0.052) and 29% for numeracy (p = 0.021) of the estimated difference in cognitive outcomes by delivery mode.”
§ The relation between cesarean birth and child cognitive development > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“This still leaves at least 70% of the relations unexplained by these mediators.”
§ The relation between cesarean birth and child cognitive development > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Combining these results, breastfeeding, obesity and ADD are found to significantly mediate the relation between cesarean birth and child cognitive outcomes, although the effects size and significance vary (Table 3).”
§ The relation between cesarean birth and child cognitive development > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 19
- The quote only partly states this claim. 2
- Probably not a substantial claim. 16
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“by up to a tenth of a standard deviation in national numeracy test scores at age 8–9”
§ The relation between cesarean birth and child cognitive development > Abstract
hedgedcorrelationaln = 3,666- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, our estimated relations persist long-term and are not confined to children with health problems.”
§ The relation between cesarean birth and child cognitive development > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The relation between cesarean birth and child cognitive development > Results
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our sample, approximately 30% of primary care givers report that their children were cesarean-born (between March 2003 and February 2004).”
§ The relation between cesarean birth and child cognitive development > Methods > Data
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“The result is long-term compositional differences in gut microbiota by mode of birth20–24, with differences observed up until age seven24.”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [23] Penders, J. et al. Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118, 511–521 (2006). source
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [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).
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In the OECD, the rate of caesarean section has increased from 14.4% of deliveries in 1990 to 25.8% in 20092”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [2] OECD. Health at a glance. Paris, (OECD 2011).
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“that are also associated with impaired functioning and lower academic performance13, 14”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [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 yetcites [14] Taras, H. & Potts‐Datema, W. Obesity and student performance at school. Journal of School Health 75, 291–295 (2005). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Abstract
What the sources say
- Not checked yetcites [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 yetcites [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).
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Data · plain
None of the sources cited for this claim have been checked yet.
In the paper
“established links between cesarean birth and adverse child health outcomes, including asthma, type I diabetes, allergies9–11 and obesity12”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Results for these alternative models are much the same as those reported in Table 2 (available upon request from the corresponding author).”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Results
What the sources say
- Not checked yetcites [50] Rivkin, S. G. & Hanushek, E. A. & Kain. J. F. Teachers, schools, and academic achievement. Econometrica 73, 417–458 (2005). source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Methods > Statistical method
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
What the sources say
- Not checked yetcites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [28] Gareau, M. et al. Bacterial infection causes stress-induced memory dysfunction in mice. Gut 60, 307–17 (2010). source
- Not checked yetcites [29] Diamond, B., Huerta, P., Tracey, K. & Volpe, B. It takes guts to grow a brain. Bioessays 33, 588–591 (2011). source
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Results > Sensitivity test results
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- 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.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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 relation between cesarean birth and child cognitive development > Methods > Statistical method
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
What the sources say
- Not checked yetcites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
What the sources say
- Not checked yetcites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Discussion
What the sources say
- Not checked yetcites [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 yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The implication is that there is a critical window to correct any disruption to the gut microbiota, after which cognitive impacts are permanent25.”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
In the paper
“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.”
§ The relation between cesarean birth and child cognitive development > Introduction
What the sources say
- Not checked yetcites [31] Bentley, J. et al. Planned birth before 39 weeks: A population-based study. Pediatrics 138, 1–9 (2016). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“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
In the citing paper
“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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The relation between cesarean birth and child cognitive development > Results
“0.008 percentage points out of the 0.076 percentage point difference (or around 11%) of the gap in grade 3 NAPLAN writing scores.”
§ The relation between cesarean birth and child cognitive development > Results
“| Writing | 0.003 | 0.002 | 0.008* | 0.000 | 0.007 | 0.000 | 0.000 |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The relation between cesarean birth and child cognitive development > Results
“0.008 percentage points out of the 0.076 percentage point difference”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
“Table: Table 2 OLS regression estimates and Oster lower-bound estimates of the relations between cesarean birth and child cognitive (standard deviations).”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The relation between cesarean birth and child cognitive development > Results
“problem solving (MR) and vocabulary (PPVT) at age 4–5 are statistically significant at the 0.1 level or higher.”
§ The relation between cesarean birth and child cognitive development > Methods > Controls
“| Problem solving 8–9 | −0.069* | (0.039) | −0.077 | (0.069) | −0.068 |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The relation between cesarean birth and child cognitive development > Methods > Data
“At the time of analysis, data were only available up until wave 5 (2014) of the survey when the children are 8–9.”
§ The relation between cesarean birth and child cognitive development > Methods > Data
“infants born between March 2003 to February 2004”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The relation between cesarean birth and child cognitive development > Methods > Outcomes
“| | Mode of birth Cesarean (n=1,080) | Mode of birth s.e. | Mode of birth Vaginal (n=2,586) | Mode of birth s.e. | p-value of diff.a |”
§ The relation between cesarean birth and child cognitive development > Methods > Outcomes
“| Female child | 0.457 | 0.498 | 0.500 | 0.500 | [0.019] |”
Citations
Cites
MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085542 · Cited by 5,688
Dominguez-Bello, M. G., Costello, E. K., Contreras, M., Magris, M., Hidalgo, G., Fierer, N., & Knight, R. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1002601107 · Cited by 4,774
Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour
Cryan, J. F., & Dinan, T. G. (2012) · Nature Reviews Neuroscience · doi:10.1038/nrn3346 · Cited by 4,572
Teachers, Schools, and Academic Achievement
Rivkin, S. G., Hanushek, E. A., & Kain, J. F. (2005) · Econometrica · doi:10.1111/j.1468-0262.2005.00584.x · Cited by 4,501
Wechsler Intelligence Scale for Children
Miles-Mason, E. (2018) · Sage eBooks · doi:10.4135/9781483392271.n537 · Cited by 4,133
Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life
Bäckhed, F., Roswall, J., Peng, Y., Feng, Q., Jia, H., Kovatcheva-Datchary, P., Li, Y., Xia, Y., Xie, H., Zhong, H., et al. (2015) · Cell Host & Microbe · doi:10.1016/j.chom.2015.04.004 · Cited by 3,315
Rosenbaum, P. R. (2002) · Springer series in statistics · doi:10.1007/978-1-4757-3692-2 · Cited by 2,543
Factors influencing the composition of the intestinal microbiota in early infancy
Penders, J., Thijs, C., Vink, C., Stelma, F. F., Snijders, B., Kummeling, I., van den Brandt, P. A., & Stobberingh, E. E. (2006) · PEDIATRICS · doi:10.1542/peds.2005-2824 · Cited by 2,232
Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms
Lubans, D., Richards, J., Hillman, C., Faulkner, G., Beauchamp, M., Nilsson, M., Kelly, P., Smith, J., Raine, L., & Biddle, S. (2016) · Pediatrics · doi:10.1542/peds.2016-1642 · Cited by 1,548
An introduction to modern missing data analyses
Baraldi, A. N., & Enders, C. K. (2009) · Journal of School Psychology · doi:10.1016/j.jsp.2009.10.001 · Cited by 1,464
Research works printed but not linked: 3
- 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).
- Dunn, L. & Dunn, D. Picture Vocabulary Test (PPVT): Peabody picture vocabulary test: PPVT. 4th ed. New Jersey, (Pearson 2015).
- 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).
Cited by
Sorted by citations
Cryan, J. F., O'Riordan, K. J., Cowan, C. S. M., Sandhu, K. V., Bastiaanssen, T. F. S., Boehme, M., Codagnone, M. G., Cussotto, S., Fulling, C., Golubeva, A. V., et al. (2019) · Physiological Reviews · doi:10.1152/physrev.00018.2018 · Cited by 5,286
Short-term and long-term effects of caesarean section on the health of women and children
Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H., Homer, C. S., Gibbons, D., Kelly, N. M., Kennedy, H. P., Kidanto, H., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31930-5 · Cited by 1,394
Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis
Rusch, J. A., Layden, B. T., & Dugas, L. R. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1130689 · Cited by 415
Zhang, T., Sidorchuk, A., Sevilla‐Cermeño, L., Vilaplana-Pérez, A., Chang, Z., Larsson, H., Mataix‐Cols, D., & de la Cruz, L. F. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.10236 · Cited by 216
Sasso, J. M., Ammar, R. M., Tenchov, R., Lemmel, S. A., Kelber, O., Grieswelle, M., & Zhou, Q. A. (2023) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.3c00127 · Cited by 229
Metadata
- Authors
- Polidano, C., Zhu, A., & Bornstein, J. C.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Polidano, Cain
- Venue
- Scientific Reports
- Published
- 2017-09-13
- Volume
- 7
- Issue
- 1
- Pages
- 11483-11483
- ISSN
- 2045-2322 (ISSN-L)
- 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
- gold
- doi.org
- 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.
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