In recent times, more and more studies are emerging that address the relationship between the gut and the brain, calling to mind the quote from Hippocrates: “All disease begins in the gut”.
Leading medical journal, JAMA, published in August of 2019 their study, which found significant association between cesarean delivery births and autism spectrum disorder as well as attention deficit/hyper-active disorder in the offspring.
In short, children born through cesarean delivery were 33% more likely to develop autism and 17% more likely to have attention deficiency disorders. The precise mechanisms were not the subject of the study, rather the correlation was observed and established.
The question posed by JAMA examined if cesarean delivery is associated with an increased risk of neurodevelopmental and psychiatric disorders in the offspring compared with birth by vaginal delivery.
To conduct their study, two researchers independently selected observational studies that examined this association and a total of 6953 articles were identified, of which 549 abstracts were selected for detailed assessment. Of the total articles selected, 61 studies comprising 67 independent samples were included, totaling 20 607 935 deliveries compared in terms of risk of neurodevelopmental disorders.
The results of this meta-analysis revealed that birth by cesarean delivery was significantly associated with increased odds of the offspring being diagnosed with ASD or ADHD compared with birth by vaginal delivery.
The article detailing this study also highlighted previous studies that had already shown children born of cesarean delivery had higher incidence of obesity, allergies, asthma, type 1 diabetes as well as increased occurrence of acute lymphocytic leukemia.
Cesarean births have, for decades, been a life-saving procedure and there is no contention over this fact.
Both offspring and mother’s life can be and often is, saved by this intervention when performed in a timely and appropriate manner.
However, acutely performed surgery does not guarantee good quality of life and health in the future and it is exactly this area that the scientific world is examining more and more closely.
Questions such as “what are the factors which so drastically impact both parties and have such consequences on later life?” have become increasingly important as the demand for these surgeries surges.
Cesarean births, as an elective procedure, are popular in America, from where the data for this article came. Since 1990, the ratio between elective cesarean delivery to vaginal birth has tripled and now 33% of new-borns come into the world through cesarean delivery.
This surgery is still primarily registered as a life-saving intervention, so it is really very important to analyse risk factors from as broad perspective as possible, looking beyond the acute risks associated with the procedure.
The risks posed by cesarean delivery are not equal for the mother and offspring; mothers have a higher risk of mortality from surgery, its complications and the child is more significantly negatively impacted by imperfectly developed intestinal flora, which can cause life-long health problems. To summarise, mothers face more acute and new-borns more chronic issues associated with cesarean deliveries.
The risk of mortality for the cesarean is four-fold for the mother, if emergency, and three-fold, if elective. 20-40% of mothers experience complications such as uterine inflammation, wound infection, urinary tract problems. Furthermore, mothers who have undergone C-sections are twice as likely to be prescribed antibiotics for infections related to the surgery and have tripled risk of needing their wombs to be removed or having heart failure.
(Source: https://www.ncbi.nlm.nih.gov/pubmed/16946213)
The leading causes of maternal mortality are infections, formation of blood clots and complications with anaesthesia.
Aside from the heavy physical burdens, the experience of birth is significantly different: in most cases, women are admitted to hospital before their due date; they feel less certain of themselves when caring for their child after the birth; give up sooner or never start breast-feeding and finally, many studies have shown, that mothers delivering through emergency or elective c-sections, tend to be more fatigued, even years after the birth of their offspring. In the long run, the idea that cesarean sections, as opposed to vaginal delivery, can prevent pelvic muscle relaxation has also been debunked.
Risks for new-borns include sluggish body temperature control, respiratory complications, and slower immune system adaptation after birth. The weaker immune system response as well as hormone production, directly or indirectly affect calcium metabolism, progesterone, dopamine, and thyroid hormone production.
The most serious consequence found by scientific exploration has been significant changes to be intestinal, or gut, flora. As early as 2011, Chris Kressler MD wrote an article which pointed out that one of the explanations in force, namely the theory of incomplete development of the gut flora, already had several supporters in the medical profession. A separate issue is, that much like handwashing, novelties in the medical field require long years to become daily practise.
Research emerging over the last decades has seen several independent studies showing altered intestinal flora in children born of cesarean section compared to those born vaginally.
Our intestinal flora supports our digestive functions on one hand as well as provides protection against infections and regulates metabolism. 75-80% of our immune system responses originate from here.
Several diseases can now be linked to altered intestinal flora: autism, autoimmune diseases, Hashimoto’s, inflammatory bowel disease and type 1 diabetes.
(Source: https://www.ncbi.nlm.nih.gov/pubmed/15168141,
https://www.ncbi.nlm.nih.gov/pubmed/1208484,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719727)
Altered intestinal flora has shown little response to breast-feeding compared to formula in infants.
(Source: https://www.ncbi.nlm.nih.gov/pubmed/20133091)
In short, breastfeeding alone cannot significantly affect the desired growth of the intestinal flora.
The solutions available show that probiotic support of the newborn is highly affective, which is most easily introduced to the them by a nipple or pacifier sprinkled with probiotic before feeding. Naturally, the right dose mixed in with the milk is the most reliable way.
Some have suggested ensuring the baby has contact with the mother’s vaginal gut flora as soon as possible, thus supporting the development of the newborn’s gut flora. For now, this path awaits further studies in terms of safety and efficacy.
Source: 28. 08. 2019. JAMA Psychiatry AMA Netw Open. 2019;2(8):e1910236. doi:10.1001/jamanetworkopen.2019.10236
Katalin is a bilingual general practitioner with more than 25 years of professional experience gained in three different European countries.
Ildiko has a clinical psychologist background and has been giving individual online mental-health support consultations in English, Dutch and Hungarian for over 15 years.