Summary: New research suggests that the mode of delivery may influence neuropsychological development in twins. In a study of twin births, children delivered by cesarean section showed a statistically higher risk of lower cognitive and neuropsychological performance compared with twins born by vaginal delivery.
Source: University of Malaga
Overview of the study
A multidisciplinary research team from the University of Malaga (UMA), combining expertise in medicine and psychology, analyzed for the first time how the type of delivery affects the cognitive and neuropsychological development of twins. Their results indicate that cesarean delivery represents an independent risk factor for developmental difficulties in children born from multiple pregnancies.
Professor Ernesto González Mesa, a gynecologist at UMA, emphasizes the particular vulnerability of twins: “Multiple births frequently end prematurely and are more likely to present complications during pregnancy and labor. The potential difficulties associated with cesarean delivery are especially relevant in these cases.” He and other gynecologists involved in the work underline the importance of promoting vaginal birth when clinically safe and reserving cesarean delivery for situations where it is medically necessary.
The study evaluated a cohort of twins born at the Hospital Materno-Infantil in Málaga in 2005. From nearly 7,000 births during that year, about 300 were multiple births; the research sample comprised 160 twins, of whom approximately 55 percent were delivered vaginally and 45 percent by cesarean section.
Methods and measures
In the first phase, researchers assessed the children’s intelligence and neuropsychological and psycho-pedagogical development using validated instruments appropriate for early primary school age. In a subsequent phase, they compared those developmental results with obstetric and perinatal variables recorded at birth, such as delivery type, complications during delivery, maternal age, newborn weight, fetal presentation, gestational age and Apgar score at one minute.
María José González Valenzuela, Professor in the Department of Developmental Psychology and Education and the study’s lead investigator, reports: “When we controlled for a range of perinatal and obstetric factors, the children who presented lower intellectual levels and delayed cognitive development were more likely to have been born by cesarean section.” The research team used statistical methods, including binary logistic regression, to evaluate the association between delivery type and later neuropsychological outcomes while accounting for other risk variables.
Implications for practice and future research
The authors stress that the findings do not imply a direct causal claim that cesarean delivery alone determines developmental outcomes. Rather, the results show an association that remains after adjusting for several relevant perinatal and obstetric variables. The study highlights the importance of early diagnosis and targeted interventions for twins who may be at increased risk of learning difficulties—particularly in reading, writing and arithmetic—so that support can begin as soon as children enter school.
Counselor Olga Cazorla Granados, a co-author, notes a growing trend in educational and clinical settings to investigate neurological and biological contributors to learning difficulties. The research team suggests that differences in neonatal exposures related to delivery type—such as early microbiome development in the gut—could be one of several mechanisms warranting further study. They recommend larger, prospective studies with broader samples to explore how obstetric choices and perinatal factors interact with genetic and environmental influences on infant neuropsychological development and general intelligence.
Source:
University of Malaga
Media contact:
María Guerrero Aguilar – University of Malaga
Image source:
The image is in the public domain.
Original research (open access)
“Type of Delivery, Neuropsychological Development and Intelligence in Twin Births.” González-Valenzuela M.-J., González-Mesa E., Cazorla-Granados O., López-Montiel D. DOI: 10.3389/fpsyg.2019.00972. The study reports that, in a retrospective cohort of 6-year-old children born in twin deliveries, cesarean delivery was associated with increased odds of verbal, non-verbal and global neuropsychological development disorders and general intellectual difficulties compared with vaginal delivery, after controlling for maternal age, fetal presentation, gestational age, birth weight and Apgar score at one minute.
Abstract summary
The retrospective cohort study assessed verbal, non-verbal and global neuropsychological maturity and general intelligence in 124 children during their first year of primary school using the Child Neuropsychological Maturity Questionnaire and the Kaufman Intelligence Test. The exposed group consisted of children born by cesarean section and the unexposed group of children born vaginally (with or without induction). Binary logistic regression analyses identified delivery type as an independent risk factor for neuropsychological and intellectual difficulties in children from multiple births. The authors call for future prospective research with larger samples to clarify the relationship between obstetric and perinatal factors and early cognitive development and to guide prevention and early intervention strategies.