Maternal Cesarean Section and Offspring ASD or ADHD Risk: A Nurses' Health Study II Analysis
Jingyuan Xiao1,2, Hayon Michelle Choi3, Gyeyoon Yim4
1Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States.
American Journal of Epidemiology
|June 27, 2026
Summary
Cesarean delivery does not increase the risk of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in children. This large study found no association between delivery mode and these neurodevelopmental outcomes.
Area of Science:
- Neuroscience
- Epidemiology
- Pediatrics
Background:
- Inconsistent epidemiological evidence exists regarding cesarean delivery's impact on offspring neurodevelopment.
- Previous studies have yielded conflicting results on the association between cesarean birth and neurodevelopmental disorders.
Purpose of the Study:
- To investigate the association between maternal cesarean delivery and the risk of childhood autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
Main Methods:
- Utilized data from the Nurses' Health Study II cohort, including 29,352 mothers for ASD and 27,704 for ADHD.
- Employed generalized estimating equations to analyze the odds ratios (OR) and 95% confidence intervals (CI) for child outcomes.
- Conducted analyses adjusting for numerous confounding factors, including maternal history and sibling comparisons.
Main Results:
- Fully adjusted models showed no statistically significant association between cesarean delivery and childhood ASD (OR=1.02, 95% CI 0.81-1.29).
- Similarly, no significant association was found between cesarean delivery and childhood ADHD (OR=1.06, 95% CI 0.95-1.18).
- Sensitivity analyses, including sibling comparisons, did not alter these primary findings.
Conclusions:
- The study does not support the hypothesis that cesarean delivery increases the risk for autism spectrum disorder or attention-deficit/hyperactivity disorder.
- Findings suggest that mode of delivery is unlikely to be a significant risk factor for these common neurodevelopmental conditions.
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:19Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by persistent deficits in social communication and interaction alongside restrictive and repetitive behaviors or interests. ASD is sometimes accompanied by intellectual impairment.
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.