Association de l'accouchement par césarienne avec le risque de troubles neuro-développementaux et psychiatriques chez la progéniture: une revue systématique et une méta-analyse

Aperçu: G.M.

Importance:

La naissance par accouchement par césarienne est en augmentation dans le monde, en particulier les accouchements par césarienne sans indication médicale. Les enfants nés par césarienne peuvent avoir un risque accru d'effets néfastes sur la santé, mais les preuves de troubles psychiatriques sont incomplètes.

Objectif:

Évaluer l'association entre l'accouchement par césarienne et le risque de troubles neurodéveloppementaux et psychiatriques chez la progéniture. 

Résultats:

Au total, 6953 articles ont été identifiés, dont 61 études comprenant 67 échantillons indépendants inclus, totalisant 20607935 accouchements. Comparativement à la progéniture née par accouchement par voie vaginale, la progéniture née par césarienne présentait une probabilité accrue de troubles du spectre de l'autisme (OR, 1,33; IC à 95%, 1,25-1,41; I2 = 69,5%) et de trouble déficit de l'attention / hyperactivité (OR, 1,17; IC 95%, 1,07-1,26; I2 = 79,2%). Les estimations étaient moins précises pour les déficiences intellectuelles (OR, 1,83; IC à 95%, 0,90 à 3,70; I2 = 88,2%), les troubles obsessionnels compulsifs (OR, 1,49; IC à 95%, 0,87-2,56; I2 = 67,3%). les TIC (OR, 1,31; IC 95%, 0,98-1,76; I2 = 75,6%) et troubles de l'alimentation (OR, 1,18; IC 95%, 0,96-1,47; I2 = 92,7%). Aucune association significative n'a été trouvée avec la dépression / les psychoses affectives ou non psychiques. Les estimations étaient comparables pour les accouchements par césarienne d'urgence et électifs. La qualité des études était élevée pour 82% des études de cohorte et 50% des études cas-témoins.

Conclusions et pertinence:

Les résultats suggèrent que les accouchements par césarienne sont associés à un risque accru de troubles du spectre de l'autisme et de déficit de l'attention avec hyperactivité, indépendamment de la modalité d'accouchement par césarienne, par rapport à l'accouchement par voie vaginale. De futures études sur les mécanismes derrière ces associations semblent être justifiées.

JAMA Netw Open. 2019 Aug 2;2(8):e1910236. doi: 10.1001/jamanetworkopen.2019.10236.

Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis

Zhang T^1,2,3, Sidorchuk A^1,2, Sevilla-Cermeño L^1,2,4, Vilaplana-Pérez A^1,2,5, Chang Z³, Larsson H^3,6, Mataix-Cols D^1,2, Fernández de la Cruz L^1,2.

Author information

1

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

2

Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.

3

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

4

Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.

5

Departament de Personalitat, Avaluació i Tractaments Psicològics, Universitat de València, València, Spain.

6

School of Medical Sciences, Örebro University, Örebro, Sweden.

Abstract

Importance:

Birth by cesarean delivery is increasing globally, particularly cesarean deliveries without medical indication. Children born via cesarean delivery may have an increased risk of negative health outcomes, but the evidence for psychiatric disorders is incomplete.

Objective:

To evaluate the association between cesarean delivery and risk of neurodevelopmental and psychiatric disorders in the offspring.

Data Sources:

Ovid MEDLINE, Embase, Web of Science, and PsycINFO were searched from inception to December 19, 2018. Search terms included all main mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

Study Selection:

Two researchers independently selected observational studies that examined the association between cesarean delivery and neurodevelopmental and psychiatric disorders in the offspring.

Data Extraction and Synthesis:

Two researchers independently extracted data according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines and assessed study quality using the Newcastle-Ottawa Scale. Random-effects meta-analyses were used to pool odds ratios (ORs) with 95% CIs for each outcome. Sensitivity and influence analyses tested the robustness of the results.

Main Outcomes and Measures:

The ORs for the offspring with any neurodevelopmental or psychiatric disorder who were born via cesarean delivery compared with those were born via vaginal delivery.

Results:

A total of 6953 articles were identified, of which 61 studies comprising 67 independent samples were included, totaling 20 607 935 deliveries. Compared with offspring born by vaginal delivery, offspring born via cesarean delivery had increased odds of autism spectrum disorders (OR, 1.33; 95% CI, 1.25-1.41; I2 = 69.5%) and attention-deficit/hyperactivity disorder (OR, 1.17; 95% CI, 1.07-1.26; I2 = 79.2%). Estimates were less precise for intellectual disabilities (OR, 1.83; 95% CI, 0.90-3.70; I2 = 88.2%), obsessive-compulsive disorder (OR, 1.49; 95% CI, 0.87-2.56; I2 = 67.3%), tic disorders (OR, 1.31; 95% CI, 0.98-1.76; I2 = 75.6%), and eating disorders (OR, 1.18; 95% CI, 0.96-1.47; I2 = 92.7%). No significant associations were found with depression/affective psychoses or nonaffective psychoses. Estimates were comparable for emergency and elective cesarean delivery. Study quality was high for 82% of the cohort studies and 50% of the case-control studies.

Conclusions and Relevance:

The findings suggest that cesarean delivery births are associated with an increased risk of autism spectrum disorder and attention-deficit/hyperactivity disorder, irrespective of cesarean delivery modality, compared with vaginal delivery. Future studies on the mechanisms behind these associations appear to be warranted.

PMID:31461150

DOI:10.1001/jamanetworkopen.2019.10236