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Associations of caesarean delivery and the occurrence of neurodevelopmental disorders, asthma or obesity in childhood based on Taiwan birth cohort study
  1. Ginden Chen1,2,3,
  2. Wan-Lin Chiang1,
  3. Bih-Ching Shu4,
  4. Yue Leon Guo5,
  5. Shu-Ti Chiou6,
  6. Tung-liang Chiang1
  1. 1 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
  2. 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  3. 3 Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
  4. 4 Department of Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
  5. 5 Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
  6. 6 Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
  1. Correspondence to Professor Tung-liang Chiang; tlchiang{at}


Objectives Whether birth by caesarean section (CS) increases the occurrence of neurodevelopmental disorders, asthma or obesity in childhood is controversial. We tried to demonstrate the association between children born by CS and the occurrence of the above three diseases at the age of 5.5 years.

Methods The database of the Taiwan Birth Cohort Study which was designed to assess the developmental trajectories of 24 200 children born in 2005 was used in this study. Associations between children born by CS and these three diseases were evaluated before and after controlling for gestational age (GA) at birth, children’s characteristics and disease-related predisposing factors.

Results Children born by CS had significant increases in neurodevelopmental disorders (20%), asthma (14%) and obesity (18%) compared with children born by vaginal delivery. The association between neurodevelopmental disorders and CS was attenuated after controlling for GA at birth (OR 1.15; 95% CI 0.98 to 1.34). Occurrence of neurodevelopmental disorders steadily declined with increasing GA up to ≤40–42 weeks. CS and childhood asthma were not significantly associated after controlling for parental history of asthma and GA at birth. Obesity in childhood remained significantly associated with CS (OR 1.13; 95% CI 1.04 to 1.24) after controlling for GA and disease-related factors.

Conclusions Our results implied that the association between CS birth and children’s neurodevelopmental disorders was significantly influenced by GA. CS birth was weakly associated with childhood asthma since parental asthma and preterm births are stronger predisposing factors. The association between CS birth and childhood obesity was robust after controlling for disease-related factors.

  • cesarean delivery
  • neurodevelopmental disorders
  • asthma
  • obesity
  • vaginal delivery

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  • Contributors GC interpreted data, wrote drafts, revised the manuscript and approved the final manuscript as submitted. W-LC carried out the initial analyses, analysed research data and approved the final manuscript as submitted. B-CS, Y-LG and S-TC interpreted research data and approved the final manuscript as submitted. T-C conceptualised and designed the study, revised the initial manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding Sponsored by the Health Promotion Administration, Department of Health and Welfare in Taiwan (DOH94&HP&1802, DOH95&HP&1802, DOH96&HP&1702, and DOH99&HP&1702).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board at National Taiwan University Hospital (No. 201604055RINC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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