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Effect of mode of birth on development of mental disorders in the offspring

Published online by Cambridge University Press:  16 December 2022

Anna Skovgaard Lerche Open the ORCID record for Anna Skovgaard Lerche [Opens in a new window] ,
Rune Haubo Christensen ,
Ole Köhler-Forsberg Open the ORCID record for Ole Köhler-Forsberg [Opens in a new window] ,
Merete Nordentoft ,
Liselotte Vogdrup Petersen ,
Preben Bo Mortensen  and
Michael Eriksen Benros
Anna Skovgaard Lerche
Affiliation:
Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
Rune Haubo Christensen
Affiliation:
Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
Ole Köhler-Forsberg
Affiliation:
Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Merete Nordentoft
Affiliation:
Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark iPSYCH The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
Liselotte Vogdrup Petersen
Affiliation:
iPSYCH The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Denmark Department of Economics – CIRRAU – Centre for Integrated Register-based Research, Denmark
Preben Bo Mortensen
Affiliation:
iPSYCH The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Denmark Department of Economics – CIRRAU – Centre for Integrated Register-based Research, Denmark
Michael Eriksen Benros*
Affiliation:
Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
*
Author for correspondence: Michael Eriksen Benros, Email: Benros@dadlnet.dk
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Abstract

Objective:

Increasing rates of caesarean sections has led to concerns about long-term effects on the offspring’s health, and it has been hypothesised that caesarean section induced differences in the child’s microbiota could potentially increase the risk of mental disorders.

Methods:

Nationwide Danish cohort study of 2,196,687 births was conducted between 1980 and 2015, with 38.5 million observation-years. Exposure was ‘Caesarean Section’ and outcome was the child’s risk of any mental disorder. Absolute and relative risks (RRs) were estimated using inverse probability weighting to adjust for age, calendar time and confounding variables while accounting for the competing risk of death.

Results:

Caesarean section (n = 364,908, 16.6%), compared to vaginal birth, was associated with a small RR increase of 8% (RR, 1.08; 95% CI, 1.04–1.13; n = 44,352) for the development of any in-patient psychiatric admission at age 36 for the offspring and with a small absolute risk difference of 0.47% (95% CI, 0.23–0.76). When looking at all in-patient, out-patient and emergency room psychiatric contacts among people born after 1995, the effect was diminished (RR, 1.04; 95% CI, 0.99–1.09; n = 15,211). The risk was comparable when comparing prelabour versus intrapartum caesarean section (RR, 0.98; 95% CI, 0.90–1.08) and acute versus planned caesarean section (RR, 1.00; 95% CI, 0.80–1.29).

Conclusion:

Birth by caesarean section was associated with only a very slightly increased risk of any in-patient psychiatric admission for the offspring and diminished even further when including all psychiatric contacts. The very small associations observed may be explained by unmeasured confounding and is unlikely to be of substantial clinical relevance.

Keywords

mental disordersperinatal carecaesarean sectioncohort studies
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 35 , Issue 2 , April 2023 , pp. 88 - 95
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

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