Table 2. Estimated Risk of Neurodevelopmental Disorders in Relatives of Individuals Delivered by Planned and Intrapartum Cesarean Delivery Compared With Individuals Delivered by Vaginal Delivery.
| Cesarean delivery | HR (95% CI) | |||
|---|---|---|---|---|
| Full maternal cousinsa | Half siblings | Full siblingsd | ||
| Paternalb | Maternalc | |||
| Any neurodevelopmental disordere | ||||
| Planned | 1.06 (0.90-1.25) | 1.33 (1.03-1.73)f | 0.96 (0.61-1.51) | 0.93 (0.81-1.06) |
| Intrapartum | 1.11 (0.97-1.26) | 0.96 (0.78-1.19) | 0.99 (0.76-1.30) | 1.07 (0.96-1.21) |
| Attention-deficit/hyperactivity disorder | ||||
| Planned | 1.07 (0.87-1.32) | 1.40 (1.04-1.89)f | 1.12 (0.68-1.84) | 0.92 (0.81-1.06) |
| Intrapartum | 1.09 (0.93-1.28) | 1.01 (0.79-1.30) | 1.11 (0.82-1.52) | 1.07 (0.95-1.20) |
| Autism spectrum disorders | ||||
| Planned | 1.07 (0.79-1.45) | 1.98 (1.08-3.63)f | 0.30 (0.10-0.94)f | 0.91 (0.79-1.04) |
| Intrapartum | 1.16 (0.89-1.51) | 1.24 (0.78-1.97) | 1.18 (0.65-2.14) | 1.07 (0.95-1.20) |
| Intellectual disability | ||||
| Planned | 1.19 (0.83-1.72) | 2.14 (1.15-3.99)f | 1.21 (0.42-3.48) | 0.88 (0.72-1.09) |
| Intrapartum | 1.31 (0.94-1.82) | 1.28 (0.75-2.19) | 0.78 (0.36-1.71) | 1.08 (0.91-1.28) |
Abbreviation: HR, hazard ratio.
This model was adjusted for child’s sex and year of birth, gestational age, age of mother and father at birth, parity, mother’s highest education level at birth, maternal and paternal history of psychiatric disorders, maternal diabetes, maternal infections during pregnancy, and large for gestational age. For intrapartum CD, we further adjusted for dystocia, failed induction, and fetal distress.
This model was adjusted for the previously named covariates except for paternal history of psychiatric disorders.
This model was adjusted for the previously named covariates except for maternal history of psychiatric disorders and further adjusted for birth order.
This model was adjusted for the previously named covariates except for maternal and paternal history of psychiatric disorders and further adjusted for birth order.
Any neurodevelopmental disorders included any diagnosis of attention-deficit/hyperactivity disorder, autism spectrum disorders, intellectual disability, tic disorders, communication disorders, or learning disorders.
Indicates significant estimates. In the within-family analyses, we identified full siblings (ie, share the same biologic mother and father), maternal half siblings (ie, share the same biologic mother but different fathers), paternal half siblings (ie, share the same biologic father but different mothers), and maternal full cousins (ie, mothers are full siblings).