Obstetric mode of delivery and risk of attention deficit hyperactivity disorder in children: insights from the Quebec pregnancy cohort
Notice bibliographique
Résumé
Attention deficit hyperactivity disorder (ADHD) prevalence in Canadian children increased 3.5-fold between 1999 and 2012, influenced by genetics and perinatal environmental factors. During the same period, cesarean section rates rose from 18.7% in 1997 to 29.4% in 2018, exceeding WHO guidelines and raising health concerns for women and children. This study aims to investigate the association between different obstetric modes of delivery and the risk of ADHD in children. Using data from the Quebec Pregnancy Cohort, we included all singleton liveborn infants insured by the provincial public drug insurance from 1998 to 2015. The mode of delivery was classified using ICD-9-CM/ICD-10-CM diagnosis and procedure codes, into four categories: unassisted vaginal delivery, assisted vaginal delivery, elective cesarean section, and emergency cesarean section. ADHD cases were identified as having at least one diagnosis, or one prescription filled for ADHD medication. Cox proportional hazards regression models were used to estimate the association between mode of delivery and the risk of ADHD in children, adjusted for potential confounding factors. Of the 229,816 eligible singletons, 72.9% were delivered through unassisted vaginal delivery, 5.9% through assisted vaginal delivery, 3.0% through elective cesarean section, and 19.5% through emergency cesarean section. The study identified 31,225 cases of ADHD (13.6%). Using unassisted vaginal delivery as reference, the adjusted hazard ratio (aHR) of ADHD was of 1.12 (95% confidence interval (CI), 1.06–1.19; 1,284 exposed cases) for assisted vaginal delivery and 1.06 (95% CI, 1.03–1.10; 5,552 exposed cases) for emergency cesarean delivery. As for elective cesarean delivery, the aHR was of 0.96 (95% CI, 0.91–1.01; 1,486 exposed cases). The findings suggest that assisted vaginal delivery and emergency cesarean section are associated with an increased risk of ADHD in children, compared with unassisted vaginal delivery after adjusting for potential risk factors. What are the association of obstetric mode of delivery and the risk of attention deficit hyperactivity disorder in children? In a cohort study of 229,816 singleton liveborn infants, assisted vaginal delivery (AVD) and emergency cesarean section (CS) are associated with an increased risk of ADHD in children, compared with unassisted vaginal delivery, with adjusted hazard ratio (aHR) of 1.12 (95% confidence interval (CI), 1.06–1.19; 1,284 exposed cases) for AVD and 1.06 (95% CI, 1.03–1.10; 5,552 exposed cases) for emergency CS. Our findings suggest that emergency CS and AVD are associated with a statistically and clinically significant increased risk of ADHD in children compared to VD. Using the overall rate of ADHD of 13.6% observed in this study, emergency CS increases the risk of ADHD to 14.4% and AVD increases the risk of ADHD to 15.2%.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».