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Schizophr Bull. 2016 May;42(3):633-41. doi: 10.1093/schbul/sbv152. Epub 2015 Nov 27.

Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study.

Author information

1
Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland;
2
Department of Public Health Sciences, Karolinska Institute, Karolinska, Sweden;
3
Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland;
4
Department of Epidemiology and Public Health;
5
Laboratory of NeuroGastroenterology, APC Microbiome Institute; Department of Psychiatry;
6
APC Microbiome Institute; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
7
Department of Psychiatry; APC Microbiome Institute;
8
Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology and Public Health; a.khashan@ucc.ie.

Abstract

Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (χ(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment.

KEYWORDS:

Caesarean; confounding; mode of delivery; psychosis; sibling control

PMID:
26615187
PMCID:
PMC4838084
DOI:
10.1093/schbul/sbv152
[Indexed for MEDLINE]
Free PMC Article

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