ArticleInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026
Cesarean delivery volume and risk of long-term neurodevelopmental disorders in offspring.
Article in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveInstitutional procedure volume has been linked to surgical morbidity and mortality, but its impact on long-term child neurodevelopment following cesarean delivery is unknown.
methodsThis retrospective, nationwide cohort study utilized South Korean National Health Insurance Service data. Cesarean births from 2010 to 2014 (n = 735 280) were followed through to 2023. Hospitals were categorized into annual volume quartiles: Q1 (≤185), Q2 (186-356), Q3 (357-600), and Q4 (>600). Multivariable Cox proportional hazards models, adjusted for maternal and obstetric covariates, estimated adjusted hazard ratio (aHR) with 95% confidence intervals (CIs) for long-term neurodevelopmental disorder (LNDD).
resultsOver a mean follow-up period of 12.4 years, LNDD was diagnosed in 31 041 children (4.2%). The incidence rates of LNDD were 3.8, 3.6, 3.1, and 3.4 per 1000 person-years for Q1, Q2, Q3, and Q4, respectively. Compared with Q1, the adjusted hazard of LNDD was 0.97 (95% CI, 0.94-0.99; P = 0.044) in Q2, 0.85 (95% CI, 0.82-0.88; P < 0.001) in Q3, and 0.90 (95% CI, 0.88-0.94; P < 0.001) in Q4. Similar inverse associations were observed for intellectual disabilities (aHRs 0.93, 0.82, and 0.83 across Q2-Q4) and for disorders of psychological development (aHRs 0.97, 0.86, and 0.92; all P < 0.001 except Q2).
conclusionHospital volume above the lowest quartile was independently associated with lower offspring LNDD hazard. The absence of a linear dose-response among higher quartiles suggests a plateau effect, emphasizing the need to optimize institutional readiness in low-volume settings to safeguard neurodevelopment.
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