Will mode of delivery at birth affect mental health later in life?

December 4, 2017 | Press Releases & Announcements

Dr. Mary Schooling

Dr. Mary Schooling

Dr. Mary Schooling, a professor at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and a team of international colleagues studied the association between mode of delivery at birth and psychological well-being among children and adolescents. The study was published in the journal Scientific Reports.

Childhood psychological well-being is a growing concern in public health as mental health issues often emerge in adolescence and extend throughout adulthood with other related adverse effects affecting health and social functioning. Mode of delivery at birth (vaginal or cesarean section) is thought to affect gut microbiota, which in turn may affect psychological well-being. As such, mode of delivery is potentially a modifiable factor for psychological well-being later in life.

Researchers used multivariable linear regression on a sample drawn from a population-representative Hong Kong Chinese birth cohort called “Children of 1997,” to examine the adjusted associations of mode of delivery with behavioral problems. The mental health of the children and adolescents was assessed based on several scores on different behavior pattern scales: parent-reported Rutter scores taken at age 7 (n = 6294) and age 11 (n = 5598), self-esteem was assessed from self-reported Culture-Free Self-Esteem Inventory score at age 11 (n = 6937), and depressive symptoms were assessed from self-reported Patient Health Questionnaire-9 score at age 13  (n = 5797).

Cesarean section (CS) was associated with children born in private hospitals, boys, and firstborns, higher maternal body mass index, higher maternal age, preeclampsia, higher socioeconomic position (SEP), and maternal birth in Hong Kong. CS was unrelated to behavior, self-esteem and depressive symptoms adjusted for infant characteristics (sex, gestational age, birthweight, parity, and breast feeding), maternal characteristics (mother’s age and place of birth) and SEP.

The findings suggest that in this developed non-Western setting, mode of delivery at birth was not clearly associated with childhood or early adolescent psychological well-being. However, the investigators see a need for additional research on the topic. Dr. Schooling explains, “Actually we found no relation between mode of delivery and adolescent mental health. We expected one because mode of delivery affects gut microbiome and thereby many aspects of health. Nevertheless, the lead author has been inspired to investigate further and just received a NIH K01 award to study the relation between the gut microbiome and adolescent mental health.”


Leung CY, Leung GM, Schooling CM. Mode of delivery and child and adolescent psychological well-being: Evidence from Hong Kong’s “Children of 1997” birth cohort. Scientific Reports. 2017;7:15673. doi:10.1038/s41598-017-15810-x.