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Am J Perinatol 2018; 35(11): 1038-1043
DOI: 10.1055/s-0038-1637001
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Elective Cesarean Delivery at Term and the Long-Term Risk for Neurological Morbidity of the Offspring

Yael Baumfeld
1   Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Eyal Sheiner
1   Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Tamar Wainstock
2   Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Idit Segal
3   Ministry of health, Jerusalem, Israel
,
Ruslan Sergienko
2   Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Daniella Landau
4   Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Asnat Walfisch
1   Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
› Author Affiliations
Funding None.
Further Information

Publication History

06 September 2017

21 January 2018

Publication Date:
06 March 2018 (online)

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Abstract

Objective The study's objective was to determine whether mode of delivery has an impact on the long-term risk for neurologic morbidity of the offspring.

Materials and Methods This population-based cohort analysis included all term singleton deliveries between 1991 and 2014. The study population was divided into two study group: elective cesarean deliveries (CD) versus vaginal deliveries (VD). Urgent cesarean deliveries, pregnancy, and delivery complications including preeclampsia and gestational diabetes were excluded. The evaluation of cumulative neurological hospitalization rate over time was performed with a Kaplan–Meier survival analysis and Cox proportional hazards models were used to study the independent association between mode of delivery and neurological morbidity while controlling for potential confounders.

Results During the study period 132,054 deliveries met the inclusion criteria, 11,746 CD (8.9%), and 120,308 (91.1%) VD. A total of 3,626 neurological hospitalizations were documented with 2.70% (3,244) in the VD group as compared with 3.25% (382) in the CD group. The survival curves showed higher cumulative hospitalization rates in the CD as compared with the VD group (p ≤ 0.001). The Cox analysis demonstrated CD to be an independent risk factor for pediatric neurological hospitalizations (p < 0.001).

Conclusion Term elective CD is an independent risk factor for neurological morbidity of the offspring.

Keywords

mode of delivery - neurological morbidity - autism - pervasive developmental disorder

Note

This study was presented in part at the 37th Annual SMFM meeting, Caesars Palace, Las Vegas, January 23–28, 2017.


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