Effect of mode of birth on development of mental disorders in the offspring.

IF 3.8 4区 医学 Q1 Medicine Acta Neuropsychiatrica Pub Date : 2023-04-01 DOI:10.1017/neu.2022.27
Anna Skovgaard Lerche, Rune Haubo Christensen, Ole Köhler-Forsberg, Merete Nordentoft, Liselotte Vogdrup Petersen, Preben Bo Mortensen, Michael Eriksen Benros
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Abstract

Objective: Increasing rates of caesarean sections has led to concerns about long-term effects on the offspring's health, and it has been hypothesised that caesarean section induced differences in the child's microbiota could potentially increase the risk of mental disorders.

Methods: Nationwide Danish cohort study of 2,196,687 births was conducted between 1980 and 2015, with 38.5 million observation-years. Exposure was 'Caesarean Section' and outcome was the child's risk of any mental disorder. Absolute and relative risks (RRs) were estimated using inverse probability weighting to adjust for age, calendar time and confounding variables while accounting for the competing risk of death.

Results: Caesarean section (n = 364,908, 16.6%), compared to vaginal birth, was associated with a small RR increase of 8% (RR, 1.08; 95% CI, 1.04-1.13; n = 44,352) for the development of any in-patient psychiatric admission at age 36 for the offspring and with a small absolute risk difference of 0.47% (95% CI, 0.23-0.76). When looking at all in-patient, out-patient and emergency room psychiatric contacts among people born after 1995, the effect was diminished (RR, 1.04; 95% CI, 0.99-1.09; n = 15,211). The risk was comparable when comparing prelabour versus intrapartum caesarean section (RR, 0.98; 95% CI, 0.90-1.08) and acute versus planned caesarean section (RR, 1.00; 95% CI, 0.80-1.29).

Conclusion: Birth by caesarean section was associated with only a very slightly increased risk of any in-patient psychiatric admission for the offspring and diminished even further when including all psychiatric contacts. The very small associations observed may be explained by unmeasured confounding and is unlikely to be of substantial clinical relevance.

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出生方式对后代精神障碍发展的影响。
目的:剖宫产率的增加引起了对后代健康长期影响的担忧,并且有人假设剖宫产引起的儿童微生物群的差异可能会增加精神障碍的风险。方法:在1980年至2015年期间,对丹麦全国2196687名新生儿进行了队列研究,共3850万观察年。暴露是“剖腹产”,结果是孩子有任何精神障碍的风险。绝对风险和相对风险(rr)使用逆概率加权来估计,以调整年龄、日历时间和混杂变量,同时考虑竞争死亡风险。结果:剖腹产(n = 364,908, 16.6%)与顺产相比,相对危险度增加8% (RR, 1.08;95% ci, 1.04-1.13;n = 44,352)对后代36岁时任何住院精神科患者的发展的影响,绝对风险差异很小,为0.47% (95% CI, 0.23-0.76)。当观察1995年后出生的人的所有住院、门诊和急诊室精神病接触时,效果减弱(RR, 1.04;95% ci, 0.99-1.09;N = 15,211)。当比较产前和产时剖腹产时,风险具有可比性(RR, 0.98;95% CI, 0.90-1.08)和急性剖宫产与计划剖宫产(RR, 1.00;95% ci, 0.80-1.29)。结论:剖宫产只与后代任何精神科住院的风险增加有非常轻微的关系,如果包括所有精神科接触,这种关系甚至会进一步降低。观察到的非常小的关联可能是由未测量的混杂因素解释的,不太可能具有实质性的临床相关性。
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来源期刊
Acta Neuropsychiatrica
Acta Neuropsychiatrica 医学-精神病学
CiteScore
8.50
自引率
5.30%
发文量
30
审稿时长
6-12 weeks
期刊介绍: Acta Neuropsychiatrica is an international journal focussing on translational neuropsychiatry. It publishes high-quality original research papers and reviews. The Journal''s scope specifically highlights the pathway from discovery to clinical applications, healthcare and global health that can be viewed broadly as the spectrum of work that marks the pathway from discovery to global health.
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