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The relationship between mode of delivery and Attention Deficit Hyperactivity Disorder: a meta-analysis and
Jiali Wei1, Zehao Zheng1, Yao Zheng2
1Beijing University of Chinese Medicine, Beijing, China.
Insights
Cesarean section (C-section) delivery is linked to a moderately increased risk of Attention Deficit Hyperactivity Disorder (ADHD) in children. This association was observed across multiple studies, highlighting a potential concern for neurodevelopmental outcomes.
Area of Science:
- Neurodevelopmental Disorders
- Pediatric Health
- Obstetrics and Gynecology
Background:
- Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder with unclear causes.
- Emerging research suggests a potential link between cesarean section (C-section) delivery and an elevated risk of ADHD.
- The etiological factors contributing to ADHD require further investigation.
Purpose of the Study:
- To investigate the association between C-section birth and the risk of developing ADHD in children.
- To synthesize evidence from observational studies using meta-analysis techniques.
- To provide a comprehensive overview of the current research on C-section delivery and ADHD risk.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, CNKI, Wanfang, VIP).
- Included studies were observational (case-control or cohort) with standardized ADHD diagnoses and extractable effect estimates.
- Data were extracted and analyzed using R Studio, pooling adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Study quality was assessed using the Newcastle-Ottawa Scale (NOS).
Main Results:
- Fourteen studies (6 case-control, 8 cohort) from 10 countries were included.
- The pooled adjusted OR for ADHD risk was 1.44 (95% CI [1.04-1.25]) for case-control studies and 1.12 (95% CI [1.10-1.15]) for cohort studies.
- Most studies adjusted for confounders like maternal age, child's sex, and gestational factors; all studies met a minimum quality score.
Conclusions:
- Cesarean section delivery is associated with a moderately increased risk of ADHD in children.
- Both elective and emergency C-sections demonstrated similar associations with ADHD risk.
- Further research is warranted to elucidate causal pathways and biological mechanisms underlying this association, acknowledging study heterogeneity and potential biases.
Background:
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in children, with an etiology that remains incompletely understood. Recent studies have suggested that the mode of delivery, particularly cesarean section (C-section), may be associated with an increased risk of ADHD. This study aims to examine whether children born via C-section are at increased risk of developing ADHD using both cohort and case-control data.
Methods:
We included observational studies (case-control or cohort) that examined the association between mode of delivery and ADHD in children. Inclusion criteria were: (a) ADHD diagnosed using standardized tools; (b) assessment of the relationship between C-section and ADHD; (c) availability of effect estimates (ORs with 95% CIs). Exclusion criteria were: (a) duplicate or overlapping data; (b) unavailable full text; (c) no extractable effect estimates. Literature searches were conducted in PubMed, Web of Science, CNKI, Wanfang, and VIP. Data were extracted using Excel and analyzed in R Studio with the meta, metabias, and metainf packages to pool the adjusted odds ratios (ORs) for the association between C-section and the occurrence of ADHD. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).
Results:
A total of 14 studies were included, consisting of six case-control and eight cohort studies across 10 countries in Asia, Europe, the Americas, and Australia. ADHD diagnoses were based on DSM-IV or ICD-10. Most studies adjusted for key confounders such as maternal age (57.14%), child's sex (50.00%), and gestational factors (35.71%). The pooled ORs were 1.44 (95% CI [1.04-1.25]) for case-control studies and 1.12 (95% CI [1.10-1.15]) for cohort studies. All studies scored ≥ 7 on the NOS.
Conclusions:
This meta-analysis suggests that C-section is associated with a moderately increased risk of ADHD in children. Both elective and emergency C-sections showed similar effects. However, limitations such as study heterogeneity, potential publication bias, and lack of genetic or biological mechanism data are to be acknowledged. Further research is needed to clarify causality and explore underlying mechanisms.
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