Childhood emotional and behavior problems and their associations with cesarean delivery

Objective: To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery. Methods: Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children's emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations. Results: A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95% CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95% CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95% CI 0.98-1.29), peer problems (OR 1.11; 95% CI 0.99-1.24), hyperactivity (OR 1.02; 95% CI 0.91-1.15), or emotional problems (OR 1.06; 95% CI 0.90-1.24). Conclusion: In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations.