| ObjectivesBased upon a birth cohort,the purpose of this study was to understand the effect of cesarean delivery on autism-like behavior in 18-month-old children,and examine the potential mediating role of breastfeeding between the association.MethodsThis study was based upon the"Ma'anshan Birth Cohort Study.Questionnaire survey was performed in the 1st,2ndand 3rdtrimester of pregnancy.Basic information of pregnant women?including maternal age,monthly income per capita,occupation,education level,etc.?and pregnancy-related information?including parity,previous adverse pregnant outcome,pregnancy complications,pregnancy related anxiety,etc.?.Delivery mode,newborn gender,birth weight,gestational week and Apgar scores were extracted from the medical records.Breastfeeding status of children at different periods and the autism-like behaviors in 18-month-old children were obtained from the infant and child health records?42 days,6 months,12 months,18 months?.Chi square tests were used to analyze the differences in maternal and child characteristics in different delivery modes,feeding styles and in children with or without autism-like behaviors.They were also used to analyze the distribution of children's autism-like behaviors in different delivery modes and breastfeeding styles.Logistic regression models were adopted to analyze the relationship between delivery mode and breastfeeding.In addition,structural equation model was introduced to testify the mediation of breastfeeding between cesarean delivery and autism-like behaviors in toddlersResultsThis study finally included 3 109 mother-infant pairs.The total cesarean delivery rate was 48.9%?1 520/3109?,and the elective cesarean delivery rate was 46.4%?1443/3109?.Among them,the rate of non-indicative elective cesarean delivery was26.4%?820/3109?,the rate of indicative elective cesarean delivery was 20.0%?623/3109?,and the rate of emergency cesarean delivery was 2.5%?77/3109?.The4-month exclusive breastfeeding rate,and rate of continuous breastfeeding in 12 months and 18 months was 45.0%?1 348/2 998?,23.7%?702/2 962?and 5.2%?154/2 944?,respectively.13.9%?406/2929?children were found to have autistic behaviors at the age of 18 months.There were statistically significant differences in the initiation of breastfeeding,onset of lactogenesis,4-month exclusive breastfeeding and 12-month continuous breastfeeding among different delivery methods?P<0.05?.There was no statistically significant difference in the rate of autistic-like behaviors in children delivered by cesarean delivery and those by vaginal delivery.Among children who were not exclusively breastfed within 4 months or not breastfed for 12 months,the rate of autism-like behaviors was higher than those who were exclusively breastfed within 4months or those were breastfed for 12 months.There was no significant difference in the rate of autism-like behaviors between children who were or were not breastfed for18 months.Compared with vaginal delivery,the OR?95%CI?of exclusive breastfeeding within 4 months in indicative elective cesarean delivery and non-indicative elective cesarean delivery women was 0.870?0.714-1.059?,0.795?0.665-0.949?,respectively,and the OR?95%CI?of continuous breastfeeding for 12 months was 0.772?0.611-0.975?,0.755?0.610-0.934?,respectively.No significant effect of cesarean delivery on breastfeeding for 18 months was observed.Structural equation model results had shown that delivery methods were indirectly related to autistic-like behaviors in children through breastfeeding.Cesarean delivery was significantly associated with a decrease in the 4-month exclusive breastfeeding rate and the 12-month breastfeeding rate,thereby increased the risk of autistic-like behaviors in 18-month children.ConclusionsCesarean section was significantly associated with a decrease in the 4-month exclusive breastfeeding rate and the 12-month breastfeeding rate.Low level of breastfeeding might mediate the association between cesarean delivery and autistic-like behaviors in toddlers. |
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