Effects Of Cesarean Section On School Children's Intelligence, Attention And Sensory Integration Function

ObjectiveBirthing is a natural process,operative delivery is to be considered only when there are clinical or "justifiable" indications for such a procedure。Cesarean delivery is not absolute security for mother and her baby.Many studies suggest that cesarean delivery can impact children's neuropsychology and influence on the intelligence level and its structure,but the results are not in accordance.In animal models abroad, dopaminergic passageway is sensitive to the diversity of mode of delivery.Some clinical investigate suggest attention deficit hyperactivity disorder(ADHD),is associated with dopaminergic neurotransmitter dysbolismus in brain,is probably connect with cesarean delivery in some degree.But no study we found whether or not cesarean delivery can impact school children's attention.Sensory integration function is intimately connect with children's learning capacity and psychological well-being. At present,whether or not cesarean delivery can be a risk factor of school children's sensory integration dysfunction,the results are not in accordance.Cesarean delivery can be divided to cesarean delivery without medical indication and cesarean delivery with medical indication.As the medical indication for cesarean delivery,maternal obstetric complications probably cause to foetus chronic hypoxia in uterus and brain injured.It maybe impact children's intelligence,attention and sensory integration function.So we select healthy school children as subjects,divided to naturally delivered group,elective cesarean delivered group and cesarean delivery with medical indication group,to investigate the effect of mode of delivery on children's intelligence, attention and sensory integration function.MethodsSubjects were the school children aged 6～12 years to request health examination in our developmental paediatrics department from December 2007 to February 2009. Preclude ADHD according to DSM-IV,and preclude other factors that could impact on children's intelligence,attention and sensory integration function.All of children met IQ＞85.The intelligence and attention of 308 school children were tested by means of the Chinese revised Wechsler Intelligence Scales for Children(C- WISC)and Integrated Visual and Auditory Continuous Performance Test(IVA-CPT).Of these children,105 cases were naturally delivered,101 cases were delivered by elective cesarean section, and 102 cases were delivered by cesarean section with medical indication.Their age,sex,birth weight,homestyle,income,the major person who take care of child were not statistically significant in three groups.And reproductive age,culture level, occupation of their father and mather were not statistically significant in three groups. Parents were asked to complete two questionnaires,the general information questionnaire made by ourselves,the sensory integration test scales(301 cases completed).Variance analyses and SNK test was used to analyze scores in three groups.All tests of significance used the.05 level of significance and were two tailed.Results1.Analyses of C-WISC scores of three groupsThe full intelligence quotient(FIQ),verbal IQ(VIQ) and performances IQ(PIQ) were not statistically significant in three groups.But Digit Span of intelligence structure and memory and care factor scores were significantly different in three groups.Digit Span:naturally delivered group scored significantly higher than elective cesarean delivered group and cesarean delivery with medical indication group;memory and care factor scores:naturally delivered children scored significantly higher than cesarean delivery with medical indication group.2.Analyses of IVA-CPT scales of three groupsThe naturally delivered group scored similar to elective cesarean delivered group,while cesarean delivery with medical indication group scored lowest in three groups.9 scales,including Full Scale Response Quotient and other scales,were statistically different in three groups.No scales was statistically different between naturally delivered group and elective cesarean delivered group;8 scales were statistically significant between naturally delivered group and cesarean delivery with medical indication group;8 scales were statistically significant between elective cesarean delivered group and cesarean delivery with medical indication group.3.Analyses of sensory integration function scores of three groupsNaturally delivered group scored highest,while cesarean delivery with medical indication group scored lowest in three groups exceptⅧfactor.There were statistically differences in three groups.Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅸfactor:naturally delivered group scored significantly higher than elective cesarean delivered group;Ⅰ,Ⅲ,Ⅳ,Ⅴ,Ⅸfactor elective cesarean delivered group scored significantly higher than cesarean delivery with medical indication group;exceptⅧfactor,the rest of factor:naturally delivered group scored significantly higher than cesarean delivery with medical indication group.Conclusion1.With or without indication,cesarean delivery has no effect on children's intelligence.But cesarean delivery has probably impact on intelligence structure.Even if excluding medical indication,elective cesarean section has still impact on intelligence structure.2.Simple cesarean section probably has no significant effect on the ability of response control and attention of school children,while medical indication for cesarean section probably is major reason of response control and attention contribution.3.With or without indication,cesarean delivery has effects on children's sensory integration function.And the medical indication has increased bad effects on children's sensory integration function of cesarean delivery.