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Abstract：
The recommendation of non-indicated caesarean section (CS) after 39 gestational weeks has been announced based on evidence of maternal and infant physiological effects. The potential psychological risks have not been acknowledged. This study aims to investigate emotional and behavioral problems in pre-school children born with elective CS (ECS) on maternal request prior to 39 weeks.
Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children\'s emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages.
The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks.
Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.
Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children\'s emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages.
The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks.
Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.
摘要：
根据母婴生理影响的证据，已经宣布了39孕周后未指示剖腹产（CS）的建议。潜在的心理风险尚未得到承认。这项研究旨在调查39周前应母亲要求出生的选择性CS（ECS）的学龄前儿童的情绪和行为问题。
2008年11月至2010年10月期间，妊娠12周以内的孕妇应邀参加了中国-安徽出生队列研究（C-ABCS）。要求他们在妊娠的第1个月和第3个月分别填写一份自我管理问卷，以收集孕妇的基本特征。从医学笔记中提取了妊娠并发症和分娩方式。他们的单胎活产在学龄前进行了随访。父母完成优势和困难问卷（SDQ）以评估儿童的情绪和行为问题。共有3319对母子进行了最终分析。使用描述性分析和二元逻辑回归分析来评估分娩方式对不同胎龄的SDQ维度异常的影响。
在39周之前，根据母亲的要求，ECS的患病率，在39-40周，41周后分别为16.6%、23.7%和15.9%，分别。与阴道出生的人相比，应母亲要求出生的ECS患儿更有可能出现总的疑难问题(RR1.519,95%置信区间1.077~2.142).母亲要求的ECS是39孕周之前出生的儿童的情绪问题（3.479，1.676至7.222）和总困难问题（2.172，1.175至4.016）的独立预测因子。
经母亲要求由ECS分娩的儿童在学龄前39孕周之前出现情绪和行为问题的风险增加。在39周之前的潜在心理影响已被添加到ECS对产妇请求的影响名册中。需要进一步的研究来探索潜在的生物学机制。
2008年11月至2010年10月期间，妊娠12周以内的孕妇应邀参加了中国-安徽出生队列研究（C-ABCS）。要求他们在妊娠的第1个月和第3个月分别填写一份自我管理问卷，以收集孕妇的基本特征。从医学笔记中提取了妊娠并发症和分娩方式。他们的单胎活产在学龄前进行了随访。父母完成优势和困难问卷（SDQ）以评估儿童的情绪和行为问题。共有3319对母子进行了最终分析。使用描述性分析和二元逻辑回归分析来评估分娩方式对不同胎龄的SDQ维度异常的影响。
在39周之前，根据母亲的要求，ECS的患病率，在39-40周，41周后分别为16.6%、23.7%和15.9%，分别。与阴道出生的人相比，应母亲要求出生的ECS患儿更有可能出现总的疑难问题(RR1.519,95%置信区间1.077~2.142).母亲要求的ECS是39孕周之前出生的儿童的情绪问题（3.479，1.676至7.222）和总困难问题（2.172，1.175至4.016）的独立预测因子。
经母亲要求由ECS分娩的儿童在学龄前39孕周之前出现情绪和行为问题的风险增加。在39周之前的潜在心理影响已被添加到ECS对产妇请求的影响名册中。需要进一步的研究来探索潜在的生物学机制。
