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Poster #202 - Are childbirth interventions and complications related to child temperament?

Fri, March 22, 2:30 to 3:45pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction: Despite widespread use of pharmaceutical and surgical birthing interventions, little is known about the effects of obstetrical factors on child emotional and behavioral development. Caesarean section and low Apgar scores have been linked with higher risk of internalizing problems (Kingston, Heaman, Brownell, & Ekuma, 2015; Razaz et al., 2016; Sirvinskiene, Zemaitiene, Jusiene, & Markuniene, 2016), but research results are conflicting. Studies on the effects of pharmaceutical interventions are scarce, although oxytocin infusion is believed to affect oxytocinergic system in newborns with potentially long-lasting effects on social development (Gialloreti, Benvenuto, Benassi, & Curatolo, 2014). Especially the research focusing on epidural anesthesia is lacking, but one study has reported that children whose mothers had epidurals at childbirth displayed lower empathy (Cassels, 2014). The present study examined associations between Caesarean section, synthetic oxytocin, epidural anesthesia, 5-minute Apgar score, and temperament in three-year-old children.
Hypothesis: Notwithstanding limited evidence of links between perinatal/obstetric factors and child behavioral/emotional outcomes, we hypothesized that birthing interventions and low Apgar score would be associated with higher Negative Affectivity and lower Surgency and Effortful Control.
Study population: Women (n = 272) were recruited from five maternity hospitals in a Central European country during prenatal medical checks. Exclusion criteria included maternal pregnancy pathology that might have affected fetus development (e.g., diabetes, hypertension), multiple pregnancy, pre-term birth (< 36 gestational weeks), and low birth weight (< 2500 g). Women with vaginal operative delivery or Caesarean section on request were also excluded from analyses, as these groups were too small to be considered separate categories.
Methods: Child temperament was measured at age 3 by mother-report on the Children’s Behavior Questionnaire (CBQ-VSF) (Putnam & Rothbart, 2006). Mode of delivery was classified into spontaneous vaginal delivery, planned CS for medical reasons and emergency CS. Multiple linear regressions controlling for potential covariates (maternal age, parity, education, marital status and child sex) were performed to assess effects of Caesarean section, synthetic oxytocin, epidural and 5-minute Apgar score on child temperament.
Results: The overall fit of the model predicting Effortful Control was significant (F(12,259) = 2.2, p = 0.01), and indicated intrapartum epidural predicted significantly lower Effortful Control (B = -0.76 (SE = 0.29), t = -2.62, p = 0.009). The overall model for Surgency was not significant (F(12,259) = 1.24, p = 0.26), but epidural anesthesia was associated with higher Surgency (B = 0.54 (SE = 0.26), t = 2.10, p = 0.037). Birthing complications and interventions were not significantly related to Negative Affectivity (F(12, 259) = 1.03, p = 0.42)(see Table 1).
Conclusions: In contrast to prior research indicating a higher risk of internalizing problems in children with lower Apgar scores and in children whose mothers underwent Caesarean section, we found no link between these factors and child Negative Affectivity. Administration of epidural anesthesia, however, may have an enduring influence on child behavior. Because high Surgency and low Effortful Control may place children at risk for externalizing problems (Gartstein, Putnam & Rothbart, 2012), greater research regarding long-term effects of childbirth pain relief procedures is warranted.

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