妊娠与儿童健康杂志

抽象的

The Influence of Mode of Delivery on the Neurodevelopment of Children and Adolescents

Joana Patrícia Meireles and Humberto S Machado

Background: Cesarean section is one of the most frequently performed surgical procedures in the world and its rates have been increasing worldwide over the past decades. Despite being a lifesaving procedure in emergent situations, it can be associated with a range of adverse maternal and childhood health outcomes. To date, there is a lack of consistent studies regarding the association between mode of delivery and a child’s neurodevelopment.
Objective: The aim of this review is to highlight the possibility of neurocognitive outcomes during childhood and adolescence being affected by the child’s mode of delivery.
Method: Literature review based on studies published between 2005 and 2018, available on PubMed.
Results: Regarding uncomplicated pregnancies and deliveries most studies found no difference in neurodevelopment according to mode of delivery, apart from nonplanned cesarean, which usually correlates to worse outcomes. In breech presentation, shortterm outcomes of children born vaginally were poorer while long-term neurological outcomes were contradictory. Preterm infants were more commonly associated with adverse neurological outcomes and these varied according to the age at which children were assessed. Considering drug administration during delivery, the long-term neurological effects of children exposed to exogenous oxytocin are not known and transitory neonatal exposure to anaesthetic drugs during delivery probably won’t harmfully influence longterm neurodevelopment.
Conclusions: Neurodevelopment is influenced by a vast number of genetic and environmental variables, becoming impracticable to account for all factors that may affect neurocognitive outcomes. Therefore, future investigation is necessary to enlighten if neurodevelopment is in fact associated with mode of delivery or if underlying causes are the real influencers. Thus, when considering mode of delivery, every obstetrical case should be individually analysed, maternal and neonatal risks and benefits should be balanced and common beliefs demystified to help mothers make an informed decision and promote their children’s healthy development.