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The association between mode of birth delivery and attention-deficit/hyperactivity disorder: a systematic review
Jitka Klugarová1, Kateřina Janoušková2,3, Martin Procházka3
1Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno.
Insights
Caesarean birth may slightly increase the risk of attention-deficit/hyperactivity disorder (ADHD) in children. This systematic review synthesizes evidence on the association between delivery mode and ADHD development to inform clinical understanding.
Area of Science:
- Obstetrics and Gynecology
- Child Development
- Neurobehavioral Disorders
Background:
- Caesarean section rates are rising globally, necessitating research into its long-term effects.
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children.
- Potential mechanisms linking caesarean birth to ADHD include altered microbiota and stress responses.
Purpose of the Study:
- To systematically review and synthesize evidence on the epidemiological association between mode of delivery and ADHD risk.
- To address the gap in systematic reviews examining the influence of delivery mode on ADHD development.
Main Methods:
- A three-step search strategy will identify published and unpublished studies across multiple databases (MEDLINE, CINAHL, EMBASE, etc.).
- Studies will be selected, appraised, and data extracted following PRISMA and Joanna Briggs Institute (JBI) guidelines by two independent reviewers.
- If feasible, a meta-analysis will be conducted using JBI's System for the Unified Management, Assessment and Review of Information (SUMARI), assessing statistical heterogeneity.
Main Results:
- This section is to be populated upon completion of the review and data synthesis.
- Anticipated results will quantify the association between caesarean delivery and ADHD risk compared to vaginal delivery.
Conclusions:
- This systematic review will provide a comprehensive overview of the current evidence on the relationship between delivery mode and ADHD.
- Findings will inform healthcare providers and parents about potential developmental implications of birth by caesarean section.
Abstract:
Caesarean section is currently the most frequently performed intervention after episiotomy in obstetrics and one of the most common abdominal operations overall. Rates of caesarean section have been rising globally. Given the increasing rate worldwide it is therefore necessary and important to understand how caesarean section affects child development. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioural disorder in children. ADHD is characterized by a combination of symptoms including inattention, impulsivity and hyperactivity. Caesarean section may affect psychological development through changes in microbiota or stress response, and birth by caesarean section can be associated with a small increased risk of ADHD. In the current literature, there is no systematic review or protocol of the systematic review answering the question of whether the mode of delivery has influence on the risk of ADHD development.The objective of this review is to synthesize the best available evidence regarding the epidemiological association between the mode of delivery (caesarean section versus vaginal delivery) as exposure and ADHD as the outcome.A three-step strategy will be utilized in this review, aiming to find both published and unpublished studies. The initial search will be conducted using the MEDLINE, CINAHL and EMBASE. The second search will involve 21 databases and sources. Following the Preferred Reporting Items for Systematic Review and Meta-analysis statement analysis of title, abstracts and full texts, critical appraisal and data extraction will be carried out on selected studies using standardized instruments developed by Joanna Briggs Institute. All steps will be performed by two independent reviewers. If possible, statistical meta-analysis using Joanna Briggs Institute within the System for the Unified Management, Assessment and Review of Information will be pooled. Statistical heterogeneity will be assessed.The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment is not needed - we will search/evaluate the existing sources of literature.
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