Birth by Cesarean Section and Academic Achievement in Adolescents: A Randomized Control Trial

Background: Despite the cesarean section (CS) associated morbidities, only few studies have focused on long-term associations for children delivered by CS. Although some previous studies have suggested association between CS and neurodevelopmental disorders leading to poor academic achievement, none were randomized in design and findings could be at high risks of performance or detection bias. Also, most previous studies suffer from a long-term follow-up time and a lack of adjustment for major confounders. Objectives: To determine the impact of CS birth route on academic achievement among adolescents. Materials and methods: A randomized control trial was conducted in consenting 210 senior secondary 3 students offering economics in four coeducational schools. The mode of delivery was categorised as: vaginal delivery (VD), and cesarean section (CS). Following an initial base line pretest assessment, coeducational schools were randomized into 4 different arms viz Diagnostic Quantitative Economics Skill Test (DQEST) with feedback and remediation (CS=8; VD=52), DQEST with feedback (CS=4; VD=58), DQEST without feedback and remediation (CS=8; VD=35), and no DQEST, (CS=8; VD=37). Seven weeks post-intervention, posttest was done on all the participants to ascertain effect of CS on academic performance. The exclusion criteria were refusal of follow-up and students inability to know their route of birth. The students’ pretest and posttest scores were obtained using a Test of Achievement in Quantitative Economics (TAQE) comprising of 20 multiple-choice questions. Analysis was by SPSS version 23. A p-value ≤0.05 was taken as significant. Results: Of the 210 students randomized, 28 were delivered via CS while 182 were delivered via VD. The mean age was 18.6 ± 3.1 years (16-20 years). The result of pretest revealed no significance difference in the performance between adolescents that were delivered via CS and those delivered via VD in each of the group (P>0.05, for all). Post test results showed that among participants that were randomized into the control group that did not receive any of diagnostic test, feedback or remediation, adolescents delivered via CS performed significantly lower compared with those that had VD (p=0.0393). Conclusion: Without diagnostic test, feedback and/or remediation, adolescents delivered by CS had significantly lower academic achievement. Further research is needed to check the consistency of findings and to identify whether the relationship is causal.