Caesarean delivery on maternal request and childhood psychopathology: a retrospective cohort study in China


Dr J-M Liu/Dr X Zheng, Institute of Reproductive and Child Health, Peking University Health Science Center, Research Center Building, 38 College Road, Haidian, Beijing 100191, China. Emails;


Please cite this paper as: Li H-T, Ye R, Achenbach T, Ren A, Pei L, Zheng X, Liu J-M. Caesarean delivery on maternal request and childhood psychopathology: a retrospective cohort study in China. BJOG 2011;118:42–48.

Objective  To prospectively examine the association between mode of delivery and childhood psychopathology.

Design  Retrospective cohort study.

Setting  Eighteen counties and three cities in China.

Population  A total of 4190 preschool children whose mothers were registered in a perinatal surveillance programme were assessed with the Child Behaviour Checklist (CBCL), an instrument to assess child emotional (internalising) and behavioural (externalising) problems.

Methods  Differences in CBCL problem scores were analysed both quantitatively and categorically among children born by caesarean delivery on maternal request (CDMR), assisted vaginal delivery (AVD), and spontaneous vaginal delivery (SVD).

Main outcome measures  The CBCL total, externalising, and internalising scores.

Results  There were significant differences in the mean scores of total (20.9, 23.0, and 25.0), externalising (7.6, 8.4, and 9.1), and internalising (4.7, 5.2, and 5.6) problems among children born by CDMR, SVD, and AVD, after adjusting for potential confounding factors (= 0.007, 0.014, and 0.031). Children born by AVD were more likely than those born by SVD to have total (OR 1.43; 95% CI 1.10–1.86), externalising (OR 1.46; 95% CI 1.11–1.92), and internalising (OR 1.41; 95% CI 1.08–1.84) scores in the highest quartile, whereas children born by CDMR were less likely to have externalising scores in the highest quartile (OR 0.64; 95% CI 0.42–0.97). Furthermore, there were significant increasing linear trends on all problem scores, and in the odds of being in the highest quartile, from children born by CDMR to those born by SVD and AVD.

Conclusion  The likelihood of childhood psychopathological problems may be the lowest in children born by CDMR, followed by those born by SVD, whereas the highest probability was observed in those born by AVD.