Mode of Birth and Specific Learning Disabilities: A Systematic Review

In many countries, including Greece, cesarean section (CS) birth rates have exceeded globally accepted levels and the European average, raising concerns about health risks. CS has been linked to adverse outcomes in children, including obesity, metabolic disorders, type 1 diabetes, and neurodevelopmental conditions. Some research suggests lower cognitive performance in CS-born children compared to vaginally born peers. However, the connection between CS and specific learning disabilities (SLDs) remains unexplained and has yet to be clarified. This systematic review aims to assess studies exploring the potential link between CS and SLDs. A systematic search was conducted in Scopus, PubMed, and ScienceDirect from inception to January 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration: CRD 42022383362). Relevant keywords were used to identify observational studies, and the Joanna Briggs Institute's Critical Appraisal Checklist was employed to assess methodological quality. From 1,921 screened titles and abstracts, 219 studies were selected for full-text review, and 10 met the inclusion criteria. Most studies used registry data, with some employing interviews or validated tests. Eight studies suggested CS as a possible risk factor for SLDs, but after adjusting for confounders, only two showed statistically significant results. Some studies lacked adjustments, and two studies highlighted the distinction between elective and emergency CS as a potential confounder. Given the limited number of studies and the variability in their findings, the evidence remains inconsistent in supporting a potential association between CS and SLDs. Future research should adopt a multidisciplinary diagnostic approach and emphasize the use of validated tools for diagnosing SLDs, account for confounding variables, and distinguish between elective and emergency CS procedures.