The Effect Of Childbirth Stress On Children’s Developmental Behavior Born With Elective Cesarean Section: A Birth Cohort Study

ObjectiveTo examine the effect of elective cesarean section(ECS)on children’s developmental behaviors,and to investigate the role of stress hormones in bridging delivery modes and children’s developmental behaviors.MethodsBased on Ma’anshan Birth Cohort(MABC),a total of 3 474 pregnant women living in Ma’anshan more than 6 months and searching for obstetric care within 14gestational weeks in Ma’anshan Maternal and Child Care Center were recruited from May 2013 to September 2014.Excluding participants with pregnancy termination(n=162),twin pregnancy(n=39),assisted delivery(n=14),emergency cesarean section(n=76),unclear delivery mode(n=141)and incomplete developmental behavior assessment(n=791),totally 2 551 mother and infant pairs entered the final analysis.Information of maternal basic demographic characteristics,pregnancy histories,pregnancy life style and pregnancy-related diseases were collected by using self-complied maternal and child health questionnaire.Delivery modes and information of infants’general condition were acquired from obstetric record.Ages and Stages Questionnaires-third edition(ASQ-3)was used to assess children’s communication,gross motor,fine motor,problem solving and person-social function,which was completed at the age of 6 months and 18 months,respectively.200 infants born with spontaneous vaginal delivery and 200 infants delivered by ECS were selected from the borth cohort.The selection criteria were:1)not less than 38 gestational weeks;2)nomal birth weight;3)without severe pregnanct or obstetric conplications;4)without neonatal asphyxia or birth defect.The levels of stress hormones which included corticotropin releasing hormone(CRH),adrenocorticotrophic hormone(ACTH),cortisol(COR),epinephrine(EPI)and norepinephrine(NE)were analyzed at birth.By regarding vaccination as pain stress,salivary was collected before and 30 min after injection at the age of 18 months.Levels of stress hormones in umbilical serum and cortisol levels in salivary were measured with enzyme linked immunosorbent assay(ELASA),and to determine the role of stress hormones in bridging different delivery modes with children’s developmental behaviors.Chi-square tests and independent t tests were used to compare demographic characteristics in various delivery modes and children’s developmental behavior problems.Multi-factor non-conditional binary logistic regression model was used to analyze the association between ECS and children’s developmental behaviors.Mann-Whitney U test was used to compare the level of umbilical hormones and salivary cortisol in different delivery modes.The relationship between umbilical hormones levels and children’s developmental behaviors was tested by chi-square test.Multi-factor non-conditional binary logistic regression model was used to analyze the association between umbilical hormones levels and children’s developmental behaviors.ResultsThe prevalence of cesarean section was 48.50%(1 519/3 132),among which ECS rate was 46.07%(1 443/3 132).In analyzed 2251 pregnant women,the average age was(26.73±3.49)years old at delivery.The average BMI of women before pregnancy was(20.81±2.80)kg/m~2.The maternal delivery age and pre-pregnancy BMI were higher in the ECS group than in the spontaneous delivery group(both P<0.001).The incidence of gestational diabetes was higher in women with ECS group(P<0.001).The child birth weight,6-month-old weight and 18-month-old weight were higher in the ECS group than in the spontaneous delivery group(P<0.001,P=0.002 and P=0.002).Chi-square test showed that the ECS was associated with children’s gross motor problems at the age of 6 months(P=0.011).Multi-factor non-conditional binary logistic regression model found that the ECS increased the risk of the delay in gross motor in children at 6 months(RR=1.61,95%CI:1.04-2.50).The levels of neonatal umbilical CRH in ECS group were higher than those born with spontaneous vaginal delivery group(P=0.024),and the levels of umbilical cortisol were lower than those born with spontaneous vaginal delivery group(P<0.001).Chi-square test showed that the low level CRH was associated with children’s gross motor function in 6 months(P=0.047),and both low and high levels group of umbilical cortisol were associated with children’s person-social function in 6 months(P=0.034).Multi-factor non-conditional binary logistic regression model found that the lower levels of umbilical CRH would decrease the risk of the delay in gross motor on children at 6 months(RR=0.26,95%CI:0.09~0.71).ConclusionECS affected gross motor development in children at the age of 6 months.Low levels of umbilical CRH would decrease the risk of children’s gross motor function in 6months,suggesting that umbilical CRH levels may bridge the association between ECS and children’s developmental behaviors at 6 months.The results thus provide evidence for rational choice of clinical obstetrics and decision of delivery modes.With increasing cesarean section rate,this study would build a bridge between perinatal physiology and preventive medicine,and it is expected to contribute to control the rate of ECS,which with a certain significance of clinical medicine and public health.