Mode of delivery and child and adolescent psychological well-being: Evidence from Hong Kong's "Children of 1997" birth cohort

Mode of delivery (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. Here we examined the association of mode of delivery with child and adolescent psychological well-being. We used multivariable linear regression in a population-representative Hong Kong Chinese birth cohort, "Children of 1997," to examine the adjusted associations of mode of delivery with behavioral problems assessed from parent-reported Rutter score at similar to 7 (n = 6294) and similar to 11 years (n = 5598), self-esteem assessed from self-reported Culture-Free Self-Esteem Inventory score at similar to 11 years (n = 6937) and depressive symptoms assessed from self-reported Patient Health Questionnaire-9 score at similar to 13 years (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. In a developed non-Western setting, mode of delivery was not clearly associated with childhood or early adolescent psychological well-being.