AS and Caesarean Birth

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I would not normally post "latest research", but this new study is large - 400,000 Scottish school children - and supports the idea that the likelihood of Special Educational Needs (including autism / AS) increases with prematurity and caesareans, as well as after week 41. There were 18,000 children (4.9%) with SEN, 10% of which were atributable to preterm or late birth, but there is no breakdown of SEN within the paper.

http://news.bbc.co.uk/2/hi/health/10274047.stm


http://www.plosmedicine.org/article/inf ... rticles%29

Hmm... I saw this too. I don't doubt that there is a probably a statistically significant increase in special needs in premature births. There is an increased risk for many diseases if you are born before term.

I'm not a statistician by any accounts, but this study is about premature births, not C sections. The normal date for elective (planned) C-sections is 39 weeks. Bear in mind that term for vaginal births can range from 37 to 42 weeks and still be called normal. Any C-sections before 39 weeks are usually medically indicated i.e. things would be a lot worse for the baby and/or mum if pregnancy was allowed to continue until term.

C-sections are on the increase, but most are medically indicated, not a case of 'too posh to push' as the media suggests. The infant mortality has not suffered from this increase, and in fact is greatly decreased. Whether you could argue this is due to c-sections being performed when medially necessiated is a whole other debate.

According to this study, infants delivered at 37 to 39 weeks had an odds ratio of 1.16, 95%,(CI) 1.12–1.20. Which basically means the chance of having a learnign difficulty (again not quanified too well), is a 1.16: 1 ratio (or between 1.12 or 1.20). Forgive me if my maths is wrong (it might very well be), but that looks like the increased risk is up by only 0.5%. That's pretty negligible.

Also, bear in mind that this study is looking back retrospectively at the affected/non affected children's delivery. Case controlled trials are useful for throwing up hypotheses, but you cannot 'prove' a link or aetiological cause without randomised control trials, or at least a cohort study.

Basically, all this study seems to be saying is that the more premature your baby is, the more likely it is to have learning difficulties. This isn't exactly ground breaking, and has nothing to do with mode of delivery, but as usual the media have seized on it and warped it into things like 'Autism 'More Likely' in C-sections'

So, yeah, Caesarians look set to become the new vaccines...

I can't imagine why any woman would want a Caesarean out of personal choice. I know I wouldn't want my stomach cut open.

As opposed to labour? I'd rather have my 'stomach' cleanly cut open under decent anaesthetic than have my perineum ripped to shreds passing out something the size of a melon!

The data and hospitals would prefer a natural birth, but at the end of the day, it is a personal choice and the increased risk of complications is small enough these days. I definitely don't judge women for not wanting a vaginal delivery. If that makes me too posh, well call me Lady Muck

But yeah, as I said, C-sections by choice are the rarity. Most women opt for vaginal deliveries unless contraindicated. Fair play to them

Actually "58,611 (16.2%) were delivered by cesarean section" and there is a full breakdown, and logistic regression, on mode of delivery as well as gestational age, with tables in the second link (the original paper) that I gave above.

I'm not quite sure what you mean. I never denied that any children were born by caesarian. It's that I've had a look at the graphs and paper, and as far as I can tell there's nothing saying that C sections cause autism. I presume you mean 16% of the learning disabled were delivered by C section. OK, but so what? Not to be rude but that statistic means nothing on its own.

If you can explain more about what point you're making, I'd be happy to listen.



I don't know about the US, but in the UK, the vast majority of caesarian sections are not by maternal request. Since this study was conducted on Scottish children, it would probably have been better to use data closer to home, as the NHS differs quite a bit from the American Healthcare System.

All this paper looks at is the correlation between delivery dates and learning disability. I do not think you can draw conclusions about the risk of caesarians vs. vaginal births from a paper that is 1. researching a different topic, 2. a case controlled study (i.e. open to bias) and 3. is not out to, or able to, establish causality.

The researchers are entitled to hazard their own personal guesses as to the causes, but you will need further cohort studies to properly assess their theories.

Not saying there won't be an impact, just that you need to look at other studies to find it.

I seem to be reading a different paper - the one I am referring to is the link that I posted earler, http://www.plosmedicine.org/article/inf ... rticles%29

According to the paper, in Table 3, the logistic regression results include the following multivariate odds ratios:

Vaginal, cephalic delivery 1.00
Vaginal, assisted delivery 1.04 (0-99-1.09) p=0.132
Breech delivery 1.22 (1.02-1.47) p=0.031
Cesarean (elective) 1.06 (0.99-1.13) p=0.075
Cesarean, emergency prelabour 1.19 (1.10-1.29) p<0.001
Cesarean, emergency postlabour 1.13 (1.07-1.20) p<0.001

There is no statistical evidence of SEN with elective cesarean. There is statistical evidence of SEN with breech and emergency cesarean. There is no breakdown of SEN.

No, it looks like the same paper.

By the way, next time, perhaps quote the link you wish to draw attention to, rather than expecting others to trawl through your previous posts. It doesn't take much time.



Again, you are just repeating blocks of text and statistics from the paper. What point are you trying to make exactly?

I don't have the time to read through the article again right now, but just going by what you've quoted, I take it that you agreeing with me, that the title I quoted previously "C-sections cause autism" is a fallacy?

Because just from what you've quoted, it looks that way. Elective caesareans (highlighted) are planned deliveries at 39 weeks. These are usually for normal babies (where the mother has had 2 previous C sections or more rarely, has asked for one) or when vaginal delivery is known in advance to be risky (breech, placenta praevia etc.). With a lower confidence interval of 0.99, there is no statistical increase in risk.

In fact, from your data quoted, delivering a breeched baby vaginally is more risky than a caesarian (1.22 to 1.06). Most obstetricians would not dispute this, and that is why C section delivery of breech birth is now the norm (another reason for the rise in C sections over the past few decades).

Any emergency caesarian is, by nature, carried out because something major and unexpected has occured (i.e. an emergency) and it would be more risky not to deliver the baby immediately. Obstetric emergencies themselves confer risks to the fetus and the baby is delivered to save its (and sometimes its mother's) life. In emergency situations, a caesarean usually decreases the risk of fetal distress and brain damage.



The (marginally) higher incidence of developmental disorder in emergency caesarean sections that are performed when the woman is in labour is not surprising. These are usually only performed when the woman is exhausted, the fetus is in distress, the pregnancy isn't progressing and likely won't.

It's a known risky procedure and it is for this very reason why women with high risk pregnancies are usually delivered at 39 weeks by caesarean in the first place before they go into labour and develop complications.

All in all, without further research, the marginal increase in developmental disorders in caesarean sections could be explainable by the fact that most emergency caesareans are carried out in already risky circumstances. According to this data, elective caesareans are actually 'safer' than vaginal deliveries for breech conditions and when it comes to comparing uncomplicated elective caesareans with vaginal deliveries, there is no statistical difference in risk.

I'm not going to bother typing up any more replies to what is essentially someone just hitting the copy and paste button, so I guess we'll just have to agree to disagree. Or not. As I've said, you haven't actually stated your point.

I was born via Cesarean-section 28 years ago. My mother had a difficult pregnancy, including preclemsia. Prior to my conception, my mother had a partial hysterectomy resulting in the removal of 1 1/2 of her ovaries and a fraction of her uterus. She was given odds of 1 in 3,000,000 of conception.

Anyway, I was conceived (duh!) and my mother had to stay off her feet during the final three months or so of my gestation period. She did not take any medications while she was pregnant.

I was born after 30 hours of labour in which both she and myself nearly died due to the incompetence of a quack physician.

I have a large head myself with a prominent forehead. In fact, my forehead seems to take up at least 40% of the surface of my face!

All foetuses swallow amniotic fluid, that's what gets their digestive systems "up and running" before birth.

As for the original question, I was a vaginal delivery, occipital-frontal presentation, at 40 weeks. (All the women in my mother's family carried boys late).

As for the broader question, I am neither an obstetrician nor a neonatal paedeatrician, however, with that disclaimer, I have a few thoughts:

- The preponderence of evidence suggests a genetic link for ASDs. While trauma during delivery may exacerbate deficits in neurological development, I think it very unlikely that caesarean delivery per se would present itself as a cause.

- Many complications of pregnancy are also genetically linked. Women will often share many characteristics during their preganacies with the experiences of their mothers and their mothers' families. If, then, a woman presents circumstances that suggest (or require) surgical intervention, and her child has a genetic predisposition to an ASD, then the likelihood of both factors being present in subsequent pregnancies is significantly higher.

- A diminishment of placental function, and a drop in the foetus' blood gasses is a significant emergency that necessitates caesarean delivery and presents significant risk for neurological impacts. But the caesarean delivery is a circumstance arising from the inherent problem, rather than a cause of subsequent problems.

I was born by Cesarean section because my mother had a tiny uterus, and I was diagnosed with Asperger's at 15.

Isn't the proper plural for foetus actually foeti as the plural for words that end in -us is -i?

I was not born via Cesarean but it should of been done cuz my mom was in labor for 3days after water broke. She also had a very difficult pregnancy to thou & had nausea every day; she was hospitalized 2wice for dehydration. She was also prescribed a med for it that was latter taken off the market due to suspicion of birth defects; there was a court case & it was ruled not to have caused em but company decided to pull med. I was also supposed to have been born a month latter but I was a full size so the docs may have been wrong about date. They also had said I was going to be a girl & I'm a guy thou I do have a girl personality in some ways

C - Section

I was a normal birth. It'd be interesting to see whether brain damage due to birth complications could induce symptoms of autism (say, perhaps the damage was in regions affected by autism?).
I'm definitely a genetically induced aspie, though. My father is, as my mom says, "textbook autistic," and my mother, though she doesn't want to admit it, is very aspie-esq.

EDIT: I also want to add that I know a surprising amount of people who were C-section babies, and none of them are autistic. In fact, the C-section babies I know are some of the most charismatic, neurotypical friends I have hahaha. Of course, I don't think this has anything to do with them being C-section babies. I just thought it was a funny coincidence.

Last edited by wendigopsychosis on 11 Jun 2010, 7:21 pm, edited 1 time in total.