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. 2025 Feb 25;23(1):119.
doi: 10.1186/s12916-025-03886-6.

Association between general anesthesia for cesarean delivery and subsequent developmental disorders in children: a nationwide retrospective cohort study

Yi-Chen Chen  1 , Fu-Wen Liang  2   3 , Ping-Heng Tan  4   5 , Chung-Han Ho  1   6 , Ying-Jen Chang  5   7 , Kuo-Chuan Hung  5   8 , Jen-Yin Chen  5 , Chia-Hung Yu  9   10
Affiliations

Association between general anesthesia for cesarean delivery and subsequent developmental disorders in children: a nationwide retrospective cohort study

Yi-Chen Chen et al. BMC Med. .

Abstract

Background: Exposure to general anesthetics (GA) in early childhood is associated with developmental disorders. However, few studies have addressed in-utero exposure to anesthetics during delivery and subsequent developmental disorders in the offspring. This study aimed to investigate whether GA for cesarean delivery is associated with developmental disorders in children.

Methods: Using data retrieved from the National Health Insurance Research Database linked to the Birth Reporting Database and the Maternal and Child Health Database between 2015 and 2020, this nationwide retrospective cohort study compared the incidence of developmental disorders following cesarean delivery under GA with that under neuraxial anesthesia (NA). Developmental disorders were diagnosed using the corresponding International Classification of Diseases codes traced 2-6 years after delivery.

Results: After excluding twins, children born with congenital anomalies or diseases and those with missing data, 325,309 eligible singleton pregnancies delivered through cesarean section under either GA or NA were enrolled. Of the total, 6973 of them were delivered under GA and 318,336 under NA. After propensity score-based fine stratification weighting with a model including age, socioeconomic deprivation, gestational status, infant sex, preterm delivery, low birth weight, and cesarean delivery duration, children delivered under GA were associated with a higher risk of developmental disorders diagnosed within 2 years (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 1.07-1.28), 3 years (aOR, 1.12; 95% CI, 1.04-1.21), and 4 years (aOR, 1.12; 95% CI, 1.04-1.21) compared with those under NA. This association was no longer present when the confounding effect of Apgar scores was included in the propensity-score model.

Conclusions: GA for cesarean delivery may be associated with developmental disorders diagnosed within 2-4 years after birth manifested through poorer 1- and 5-min Apgar scores. There is no evidence of a direct relationship between GA-related neurotoxicity and subsequent developmental disorders.

Keywords: Anesthesia; Apgar scores; Developmental disorders; Neurotoxicity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was exempt from full review by the Institutional Review Board of Chi Mei Medical Center (11105-E02), and a waiver of the requirement for obtaining patient consent was granted due to the use of anonymized data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Estimated effect of GA for cesarean delivery on the development of developmental disorders in children compared with NA
Fig. 3
Fig. 3
Subgroup analysis of the risk of developing developmental disorders comparing children delivered through cesarean section under GA and children delivered under NA with a 5-min Apgar score of (a) < 7 or (b) ≥ 7
See this image and copyright information in PMC

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