53 Long-term neurodevelopmental outcomes among children following forceps, vacuum, and cesarean delivery in the second stage of labour
Notice bibliographique
Résumé
Abstract Background Opportunities for training in operative vaginal delivery (forceps and vacuum delivery) have declined in Canada over the last two decades along with a concomitant increase in maternal and neonatal trauma following these deliveries. While several studies have demonstrated the acute neonatal morbidity associated with forceps and vacuum delivery in Canada, the long-term consequences of these deliveries, such as neurodevelopmental morbidity in children, remain understudied. Objectives We aimed to quantify the association between mode of delivery in the second stage of labour (forceps, vacuum, sequential instrument, and cesarean delivery) and neurodevelopmental disorders in children, namely, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID). Design/Methods We conducted a population-based, cohort study including all liveborn singletons without a congenital anomaly in British Columbia, Canada (2000-2019). Children were followed from age 1 until they experienced a diagnosis, death, emigration, or study completion, which ever came first. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) compared the incidence of ADHD, ASD, and ID in forceps, vacuum, sequential instrument, and second stage cesarean delivery groups while adjusting for several maternal demographic and clinical factors. We performed a mediation analysis to assess the contribution of severe neonatal birth trauma and birth asphyxia to the association between mode of delivery and each neurodevelopmental disorder. Results Among the 97,529 children included in the study, 8.0% developed ADHD, 2.2% developed ASD, and 0.3% developed ID. Compared with second stage cesarean delivery, children born after sequential instrument use had a 16% higher rate of ADHD (7.9 vs. 6.6 per 1,000 person-years; aHR 1.16, 95% CI 1.03-1.31) while children born with vacuum delivery had a 46% higher rate of ID (0.3 vs. 0.2 per 1,000 person-years; aHR 1.46, 95% CI 1.08-1.97). No associations between mode of delivery in the second stage of labour and ASD were found. Birth trauma and asphyxia did not considerably mediate the relationship between mode of delivery in the second stage of labour and ADHD and ID, respectively. Conclusion Compared with second stage cesarean delivery, sequential instrument use was associated with an increased risk of ADHD while vacuum delivery was associated with an increased risk of ID. Investigations into the causal relationships underlying these associations are warranted to assist pregnant individuals and their care providers in making informed decisions about mode of delivery options in the second stage of labour.
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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 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».