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Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder.

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Title: Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder.
Authors: Axelsson, Paul Bryde, Clausen, Tine Dalsgaard, Petersen, Anne Helby, Hageman, Ida, Pinborg, Anja, Kessing, Lars Vedel, Bergholt, Thomas, Rasmussen, Steen Christian, Keiding, Niels, Løkkegaard, Ellen Christine Leth
Source: Journal of Child Psychology & Psychiatry. Feb2019, Vol. 60 Issue 2, p151-159. 9p. 2 Charts, 2 Graphs.
Subjects: Antibiotics, Risk factors of attention-deficit hyperactivity disorder, Penicillin, Attention-deficit hyperactivity disorder, Biomarkers, Causality (Physics), Cesarean section, Childbirth, Confidence intervals, Delivery (Obstetrics), Longitudinal method, Research methodology, Evaluation of medical care, Medical prescriptions, Health outcome assessment, Pregnancy, Regression analysis, Statistics, Surgical complications, Vagina, Data analysis, Gut microbiota, Proportional hazards models, Preoperative period, Odds ratio, Delayed onset of disease, Intrapartum care, Children, Prognosis, Diagnosis, Prevention, Therapeutics
Abstract: Background: Increasing attention deficit hyperactivity disorder (ADHD) incidence has been proposed to be caused by factors influencing microbiota in early life. We investigated the potential causality between ADHD and two surrogate markers for changes in children's microbiota: birth delivery mode and early childhood antibiotic use. Method: This population‐based, prospective cohort study linked nationwide registers of data for native Danish singleton live births in Denmark from 1997 to 2010. Exposure variables were delivery mode and antibiotic use during the first 2 years of life. The main outcome measure was ADHD diagnosis or redeemed ADHD medication prescriptions. For statistical analysis, we used both advanced sibling models and a more traditional approach. Results: We included 671,592 children, followed from their second birthday in the period 1999–2014 for 7,300,522 person‐years. ADHD was diagnosed in 17,971. In total, 17.5% were born by cesarean delivery, and 72% received antibiotic treatment within their first 2 years of life. In the adjusted between‐within sibling survival model, mode of delivery or antibiotics had no effect on ADHD when compared with vaginal delivery or no antibiotic treatment as hazard ratios were 1.09 (95% confidence interval 0.97–1.24) for intrapartum cesarean, 1.03 (0.91–1.16) for prelabor cesarean, 0.98 (0.90–1.07) for penicillin, and 0.99 (0.92–1.06) for broader spectrum antibiotics. In a sibling‐stratified Cox regression, intrapartum cesarean was associated with increased ADHD risk, but other exposures were not. In a descriptive, nonstratified Cox model, we found increased risk for ADHD for all exposures. Conclusions: Detailed family confounder control using the superior between‐within model indicates that cesarean delivery or use of antibiotics during the first 2 years of life does not increase ADHD risk. Therefore, our study suggests that changes in children's microbiota related to cesarean delivery or antibiotic use, do not cause ADHD. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Child Psychology & Psychiatry is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder.
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  Data: <searchLink fieldCode="AR" term="%22Axelsson%2C+Paul+Bryde%22">Axelsson, Paul Bryde</searchLink><br /><searchLink fieldCode="AR" term="%22Clausen%2C+Tine+Dalsgaard%22">Clausen, Tine Dalsgaard</searchLink><br /><searchLink fieldCode="AR" term="%22Petersen%2C+Anne+Helby%22">Petersen, Anne Helby</searchLink><br /><searchLink fieldCode="AR" term="%22Hageman%2C+Ida%22">Hageman, Ida</searchLink><br /><searchLink fieldCode="AR" term="%22Pinborg%2C+Anja%22">Pinborg, Anja</searchLink><br /><searchLink fieldCode="AR" term="%22Kessing%2C+Lars+Vedel%22">Kessing, Lars Vedel</searchLink><br /><searchLink fieldCode="AR" term="%22Bergholt%2C+Thomas%22">Bergholt, Thomas</searchLink><br /><searchLink fieldCode="AR" term="%22Rasmussen%2C+Steen+Christian%22">Rasmussen, Steen Christian</searchLink><br /><searchLink fieldCode="AR" term="%22Keiding%2C+Niels%22">Keiding, Niels</searchLink><br /><searchLink fieldCode="AR" term="%22Løkkegaard%2C+Ellen+Christine+Leth%22">Løkkegaard, Ellen Christine Leth</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+Child+Psychology+%26+Psychiatry%22">Journal of Child Psychology & Psychiatry</searchLink>. Feb2019, Vol. 60 Issue 2, p151-159. 9p. 2 Charts, 2 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Antibiotics%22">Antibiotics</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+factors+of+attention-deficit+hyperactivity+disorder%22">Risk factors of attention-deficit hyperactivity disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Penicillin%22">Penicillin</searchLink><br /><searchLink fieldCode="DE" term="%22Attention-deficit+hyperactivity+disorder%22">Attention-deficit hyperactivity disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Causality+%28Physics%29%22">Causality (Physics)</searchLink><br /><searchLink fieldCode="DE" term="%22Cesarean+section%22">Cesarean section</searchLink><br /><searchLink fieldCode="DE" term="%22Childbirth%22">Childbirth</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Delivery+%28Obstetrics%29%22">Delivery (Obstetrics)</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+of+medical+care%22">Evaluation of medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+prescriptions%22">Medical prescriptions</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Regression+analysis%22">Regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Statistics%22">Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+complications%22">Surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22Vagina%22">Vagina</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis%22">Data analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Gut+microbiota%22">Gut microbiota</searchLink><br /><searchLink fieldCode="DE" term="%22Proportional+hazards+models%22">Proportional hazards models</searchLink><br /><searchLink fieldCode="DE" term="%22Preoperative+period%22">Preoperative period</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Delayed+onset+of+disease%22">Delayed onset of disease</searchLink><br /><searchLink fieldCode="DE" term="%22Intrapartum+care%22">Intrapartum care</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Prognosis%22">Prognosis</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnosis%22">Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutics%22">Therapeutics</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Increasing attention deficit hyperactivity disorder (ADHD) incidence has been proposed to be caused by factors influencing microbiota in early life. We investigated the potential causality between ADHD and two surrogate markers for changes in children's microbiota: birth delivery mode and early childhood antibiotic use. Method: This population‐based, prospective cohort study linked nationwide registers of data for native Danish singleton live births in Denmark from 1997 to 2010. Exposure variables were delivery mode and antibiotic use during the first 2 years of life. The main outcome measure was ADHD diagnosis or redeemed ADHD medication prescriptions. For statistical analysis, we used both advanced sibling models and a more traditional approach. Results: We included 671,592 children, followed from their second birthday in the period 1999–2014 for 7,300,522 person‐years. ADHD was diagnosed in 17,971. In total, 17.5% were born by cesarean delivery, and 72% received antibiotic treatment within their first 2 years of life. In the adjusted between‐within sibling survival model, mode of delivery or antibiotics had no effect on ADHD when compared with vaginal delivery or no antibiotic treatment as hazard ratios were 1.09 (95% confidence interval 0.97–1.24) for intrapartum cesarean, 1.03 (0.91–1.16) for prelabor cesarean, 0.98 (0.90–1.07) for penicillin, and 0.99 (0.92–1.06) for broader spectrum antibiotics. In a sibling‐stratified Cox regression, intrapartum cesarean was associated with increased ADHD risk, but other exposures were not. In a descriptive, nonstratified Cox model, we found increased risk for ADHD for all exposures. Conclusions: Detailed family confounder control using the superior between‐within model indicates that cesarean delivery or use of antibiotics during the first 2 years of life does not increase ADHD risk. Therefore, our study suggests that changes in children's microbiota related to cesarean delivery or antibiotic use, do not cause ADHD. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Journal of Child Psychology & Psychiatry is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jcpp.12961
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 151
    Subjects:
      – SubjectFull: Antibiotics
        Type: general
      – SubjectFull: Risk factors of attention-deficit hyperactivity disorder
        Type: general
      – SubjectFull: Penicillin
        Type: general
      – SubjectFull: Attention-deficit hyperactivity disorder
        Type: general
      – SubjectFull: Biomarkers
        Type: general
      – SubjectFull: Causality (Physics)
        Type: general
      – SubjectFull: Cesarean section
        Type: general
      – SubjectFull: Childbirth
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Delivery (Obstetrics)
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Research methodology
        Type: general
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Medical prescriptions
        Type: general
      – SubjectFull: Health outcome assessment
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Regression analysis
        Type: general
      – SubjectFull: Statistics
        Type: general
      – SubjectFull: Surgical complications
        Type: general
      – SubjectFull: Vagina
        Type: general
      – SubjectFull: Data analysis
        Type: general
      – SubjectFull: Gut microbiota
        Type: general
      – SubjectFull: Proportional hazards models
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      – SubjectFull: Preoperative period
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      – SubjectFull: Odds ratio
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      – SubjectFull: Delayed onset of disease
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      – SubjectFull: Intrapartum care
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      – SubjectFull: Children
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      – SubjectFull: Prognosis
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      – SubjectFull: Diagnosis
        Type: general
      – SubjectFull: Prevention
        Type: general
      – SubjectFull: Therapeutics
        Type: general
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      – TitleFull: Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder.
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              Text: Feb2019
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