Assessment of Cesarean Delivery and Neurodevelopmental and Psychiatric Disorders in the Children of a Population-Based Swedish Birth Cohort

Key Points Question Is cesarean delivery associated with neurodevelopmental and psychiatric disorders in children? Findings In this Swedish population-based birth cohort study of more 1.1 million children, births via planned or intrapartum cesarean delivery were associated with a moderately increased risk of neurodevelopmental disorders in children, but these associations were attenuated after adjusting for familial factors. Meaning The association between cesarean delivery and neurodevelopmental disorders may be explained by unmeasured familial confounding; observational studies on the association between prenatal risk factors and child outcomes may be spurious owing to unmeasured confounders.

• Publication year

  2021

• Venue

  JAMA Network Open

• Publication date

  2021-03-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1001/jamanetworkopen.2021.0837PMID 33666663PMCID 7936261
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Obstetric complications in bipolar disorder: Psychiatric factors and the risk of caesarean section.

  2020cited by this paper
• Association Between Mode of First Delivery and Subsequent Fecundity and Fertility

  2020cited by this paper
• Birth order and reproductive stoppage in families of children with autism spectrum disorder

  2019cited by this paper
• The Association between Autism Spectrum Disorder and Pre- and Postnatal Antibiotic Exposure in Childhood—A Systematic Review with Meta-Analysis

  2019cited by this paper
• Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring

  2019cited by this paper
• Relation Between Infant Microbiota and Autism?: Results from a National Cohort Sibling Design Study

  2019cited by this paper
• Association of breastfeeding status with risk of autism spectrum disorder: A systematic review, dose-response analysis and meta-analysis.

  2019cited by this paper
• Reproductive stoppage in autism spectrum disorder in a population of 2.5 million individuals

  2019cited by this paper
• Early exposure to antibiotic drugs and risk for psychiatric disorders: a population-based study

  2019cited by this paper
• The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research

  2019cited by this paper
• Stunted microbiota and opportunistic pathogen colonisation in caesarean section birth

  2019cited by this paper
• Early childhood antibiotics use and autism spectrum disorders: a population-based cohort study.

  2018cited by this paper
• Global epidemiology of use of and disparities in caesarean sections.

  2018cited by this paper
• Diet and Maternal Gestational Weight Gain Predict Metabolic Maturation of Infant Gut Microbiomes

  2018cited by this paper
• Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder.

  2018cited by this paper
• Birth mode is associated with earliest strain-conferred gut microbiome functions and immunostimulatory potential

  2018cited by this paper
• Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis

  2018cited by this paper
• Familial Liability to Epilepsy and Attention-Deficit/Hyperactivity Disorder: A Nationwide Cohort Study.

  2018cited by this paper
• Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis

  2017cited by this paper
• The Heritability of Autism Spectrum Disorder

  2017cited by this paper
• Bacterial colonization and succession in a newly opened hospital

  2017cited by this paper
• The Swedish cause of death register

  2017cited by this paper
• Familial liability to Epilepsy and ADHD: A Nationwide Cohort Study

  2017cited by this paper
• Registers of the Swedish total population and their use in medical research

  2016cited by this paper
• Antibiotics, birth mode, and diet shape microbiome maturation during early life

  2016cited by this paper
• Carryover Effects in Sibling Comparison Designs.

  2016cited by this paper
• The Journal of Clinical Investigation

  2016cited by this paper
• Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study

  2016cited by this paper
• Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study.

  2016cited by this paper
• Familial Liability for Eating Disorders and Suicide Attempts: Evidence From a Population Registry in Sweden.

  2016cited by this paper
• Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life.

  2015cited by this paper
• Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder: A Population-Based Sibling Design Study.

  2015cited by this paper
• Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register

  2015cited by this paper
• Research review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

  2015cited by this paper
• Evidence for ASD Recurrence Rates and Reproductive Stoppage From Large UK ASD Research Family Databases

  2015cited by this paper
• Familial Risks of Tourette Syndrome and Chronic Tic Disorders. A Population-Based Cohort Study.

  2015cited by this paper
• Natural history of the infant gut microbiome and impact of antibiotic treatment on bacterial strain diversity and stability

  2015cited by this paper
• Gut/brain axis and the microbiota.

  2015cited by this paper
• Maternal age at childbirth and risk for ADHD in offspring: a population-based cohort study.

  2014cited by this paper
• Evidence of reproductive stoppage in families with autism spectrum disorder: a large, population-based cohort study.

  2014cited by this paper
• Familial confounding of the association between maternal smoking during pregnancy and ADHD in offspring.

  2014cited by this paper
• Psychiatric illness in women requesting caesarean section

  2014cited by this paper
• The familial risk of autism.

  2014cited by this paper
• What have we learned from recent twin studies about the etiology of neurodevelopmental disorders?

  2013cited by this paper
• The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan

  2013cited by this paper
• Long-term neurodevelopmental outcome with hypoxic-ischemic encephalopathy.

  2013cited by this paper
• Sibling Comparison Designs Bias From Non-Shared Confounders and Measurement Error

  2012cited by this paper
• Sibling comparison designs: bias from non-shared confounders and measurement error.

  2012cited by this paper
• External review and validation of the Swedish national inpatient register

  2011cited by this paper
• The Swedish Multi-generation Register.

  2011cited by this paper
• Methods in Biobanking

  2011cited by this paper
• Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis.

  2010cited by this paper
• The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood.

  2010cited by this paper
• The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research

  2009cited by this paper
• Prenatal and perinatal risk factors for autism: a review and integration of findings.

  2007cited by this paper
• The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

  2007cited by this paper
• Caesarean section delivery and the risk of allergic disorders in childhood

  2005cited by this paper
• Deliveries, mothers and newborn infants in Sweden, 1973–2000

  2003cited by this paper
• The Swedish Medical Birth Register

  2003cited by this paper
• Intrauterine growth curves based on ultrasonically estimated foetal weights

  1996cited by this paper
• Resource Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life Graphical Abstract Highlights

  year unknowncited by this paper

• Long-Term Neurodevelopmental Outcomes After Forceps, Vacuum, and Second-Stage Cesarean Delivery

  2026cites this paper
• Healthcare utilization and developmental delay among infants exposed to cannabis in utero.

  2026cites this paper
• The relationship between mode of delivery and Attention Deficit Hyperactivity Disorder: a meta-analysis and systematic review

  2026cites this paper
• Psychobiotics for the treatment of neuropsychiatric, neurodegenerative, and neurodevelopmental disorders: A systematic review.

  2026cites this paper
• Prevalence of anxiety and associated risk factors among maternal and child health hospital female attenders: a cross-sectional multicenter study.

  2026cites this paper
• Cesarean delivery on maternal request and Robson classification.

  2026cites this paper
• Association of labour epidural analgesia exposure with infant neurodevelopment: secondary analysis of a prospective cohort study.

  2025cites this paper
• Mode of Birth and Specific Learning Disabilities: A Systematic Review

  2025influential citation
• Obstetric mode of delivery and risk of attention deficit hyperactivity disorder in children: insights from the Quebec pregnancy cohort

  2025influential citation
• The association between gestational selective serotonin reuptake inhibitor (SSRI) treatment and newborn thyroid screen: a large-scale cohort study

  2025cites this paper
• Perinatal risk factors and disordered eating in children and adolescents

  2025cites this paper
• Placental serotonergic system dysregulation is associated with early impairments in infant neurodevelopment

  2025cites this paper
• Genetic liability to mental disorders and being delivered via cesarean section.

  2025cites this paper
• Exploring the links between nutrition, gut microbiome and neurodevelopmental disorders

  2025cites this paper
• Neurodevelopment and Risk Factors in Infants Before, During, and After the COVID-19 Pandemic in Eastern China: Cross-Sectional Study

  2025cites this paper
• “When You Feel Like There is No Trust in the Profession”—Midwives and Obstetricians Facing Complicated Cases

  2025cites this paper
• Predictors of preschool attention-deficit/hyperactivity disorder diagnosis: a population-based study using national registers.

  2024cites this paper
• Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan

  2024cites this paper
• Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study

  2024cites this paper
• Risk of Asthma and Allergies in Children Delivered by Cesarean Section: A Comprehensive Systematic Review.

  2024cites this paper
• Pharmacologic Analgesia for Cesarean Section: An Update in 2024

  2024cites this paper
• Exploration of Risk Factors for Language Regression According to Parent Reports in Turkish Children with Autism Spectrum Disorder

  2024cites this paper
• Association between mode of delivery and early neurodevelopment: A prospective birth cohort study

  2024cites this paper
• Harnessing the power of child development records to detect early neurodevelopmental disorders using Bayesian analysis

  2024cites this paper
• A Prospective Study on Evaluating the Long-Term Effects of Childhood Vaccination from Birth to 13 Years Old in Kuwait

  2024cites this paper
• More than just a number: the gut microbiota and brain function across the extremes of life

  2024cites this paper
• Cesarean Section, Childhood Health, and Schooling: Quasi‐Experimental Evidence From Denmark, Norway and Sweden

  2024cites this paper
• Modified neuroimmune processes and emotional behaviour in weaned and late adolescent male and female mice born via caesarean section

  2024cites this paper
• Vaginale Geburt – Vor- und Nachteile für Mutter und Kind

  2024cites this paper
• Cesarean section and parenting stress: Results from the Japan Environment and Children’s Study

  2023cites this paper
• Difficulties in Adaptation of the Mother and Newborn via Cesarean Section versus Natural Birth—A Narrative Review

  2023cites this paper
• Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study.

  2023cites this paper
• Influence of Mode of Delivery on Children’s Attention Deficit Hyperactivity Disorder and Childhood Intelligence

  2023cites this paper
• Advances in reproductive medicine - health economic outcomes research assessment of treatment strategies - multiple choice questions - questions

  2023cites this paper
• Association between Cesarean section and neurodevelopmental disorders in a Japanese birth cohort: the Japan Environment and Children’s Study

  2023influential citation
• COVID-19 and Adolescent Outpatient Mental Health Service Utilization: an interrupted time series analysis

  2023cites this paper
• Identification of Autism spectrum disorder by parents: a retrospective-comparative study of the role of early behavioral signs, developmental and demographic characteristics

  2023cites this paper
• Prenatal anesthetic exposure and offspring neurodevelopmental outcomes—A narrative review

  2023cites this paper
• Association of caesarean delivery with offspring health outcomes in full-cohort versus sibling-comparison studies: a comparative meta-analysis and simulation study

  2023cites this paper
• Lasting consequences on physiology and social behavior following cesarean delivery in prairie voles

  2023cites this paper
• Differences and Relations Between Chrono-Biological and Motor-Functional Characteristics of Infants

  2023influential citation
• Associations Between Delivery Modes, Birth Outcomes and Offspring Anxiety Disorders in a Population-Based Birth Cohort of Children and Adolescents

  2022influential citation
• Use of Population-Level Administrative Data in Developmental Science.

  2022cites this paper
• Disquiet concerning cesarean birth

  2022cites this paper
• Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings

  2022cites this paper
• Association between perinatal mental health and reproductive and neonatal complications: a retrospective birth cohort study

  2022cites this paper
• Effect of mode of birth on development of mental disorders in the offspring.

  2022cites this paper
• Role of Maternal Microbiota and Nutrition in Early-Life Neurodevelopmental Disorders

  2021cites this paper
• Parity moderates the effect of delivery mode on maternal ratings of infant temperament

  2021cites this paper
• Neurodevelopment and Risk Factors in Infants Before, During, and After the COVID-19 Pandemic in Eastern China: Cross-Sectional Study

  year unknowncites this paper