{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T23:52:16Z","timestamp":1762300336704,"version":"3.40.3"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF16OC0022902"],"award-info":[{"award-number":["NNF16OC0022902"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>It is suggested that birth by elective cesarean section (CS) reduces the risk of birth\u2010related infant mortality and injury. Other studies suggest an increased risk of somatic immune\u2010related diseases among children born by CS such as asthma, type 1 diabetes, and inflammatory bowel disease. The WHO Statement on Cesarean Section Rates 2015 described an increase in CS globally. The statement concluded that the effects of CS on social and psychological outcomes remain unclear and that more research is needed to fully understand the effects of CS, including effects on cognition and intelligence in the child. Therefore, we aimed to investigate the association between delivery by CS (elective and acute) and school performance and intelligence in youth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This cohort study included all Danish live\u2010born children in 1978\u20132000. We retrieved data regarding pregnancies, births, parents, school grades, and intelligence of the children from Danish registers and performed multiple imputations to avoid discarding data. The final cohort after exclusion comprised 1\u00a0408\u2009230 children. Associations between CS and school graduation, grades, conscription attendance, and conscription intelligence scores were analyzed using univariate and multivariate logistic and linear regressions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Adjusted odds ratio with 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> of graduating from lower (<jats:styled-content style=\"fixed-case\">LSE<\/jats:styled-content>) and upper (<jats:styled-content style=\"fixed-case\">USE<\/jats:styled-content>) secondary education and of attending conscription were significantly lower in the <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> group: <jats:styled-content style=\"fixed-case\">LSE<\/jats:styled-content> graduation: 0.87 (0.84\u20130.89), <jats:styled-content style=\"fixed-case\">USE<\/jats:styled-content> graduation: 0.93 (0.92\u20130.94), attending conscription: 0.95 (0.93\u20130.98). The <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> group had significantly lower grade point averages (<jats:styled-content style=\"fixed-case\">GPA<\/jats:styled-content>) in <jats:styled-content style=\"fixed-case\">LSE<\/jats:styled-content> with adjusted differences in mean total <jats:styled-content style=\"fixed-case\">GPA<\/jats:styled-content> of \u22120.090 (\u22120.10 to \u22120.007), and mean core subject <jats:styled-content style=\"fixed-case\">GPA<\/jats:styled-content> of \u22120.098 (\u22120.11 to \u22120.08), in <jats:styled-content style=\"fixed-case\">USE<\/jats:styled-content> with total <jats:styled-content style=\"fixed-case\">GPA<\/jats:styled-content> difference of \u22120.091 (\u22120.11 to \u22120.075) and lower mean intelligence scores of \u22120.36 (\u22120.46 to \u22120.27) in adjusted linear models. A sub\u2010analysis revealed lower chances of graduating <jats:styled-content style=\"fixed-case\">LSE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">USE<\/jats:styled-content> when born by acute rather than elective <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Chances of LSE and USE graduation and of attending conscription were significantly lower for children born by CS. However, even significant differences in mean GPAs and intelligence scores were very small, so performances when graduating school and attending conscription were comparable regardless of delivery mode.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14535","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T08:05:15Z","timestamp":1679472315000},"page":"532-540","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of birth by cesarean section with academic performance and intelligence in youth: A cohort study"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0080-2639","authenticated-orcid":false,"given":"Agnes K.","family":"Ladelund","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3516-326X","authenticated-orcid":false,"given":"Julie A.","family":"Slavensky","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-054X","authenticated-orcid":false,"given":"Frederik J.","family":"Bruun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6636-155X","authenticated-orcid":false,"given":"Emilie Pi","family":"Fogtmann\u00a0Sejer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-451X","authenticated-orcid":false,"given":"Erik Lykke","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Department of Public Health University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5695-8419","authenticated-orcid":false,"given":"Steen","family":"Ladelund","sequence":"additional","affiliation":[{"name":"Global Development Novo Nordisk  S\u00f8borg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3868-106X","authenticated-orcid":false,"given":"Ulrik S.","family":"Kesmodel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Herlev and Gentofte Hospital  Herlev Denmark"},{"name":"Department of Obstetrics and Gynecology Aalborg University Hospital, Aalborg and Aalborg University, Department of Clinical Medicine  Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1586\/eog.11.5"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39363.706956.55"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.16176"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000488"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2014.910834"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1304-x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016348509155120"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181adf481"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000149743.80837.d3"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1979.tb112116.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12475"},{"key":"e_1_2_11_14_1","first-page":"320","article-title":"The Danish medical birth registry","volume":"45","author":"Knudsen LB","year":"1998","journal-title":"Dan Med Bull"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0356-1"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"e_1_2_11_17_1","first-page":"263","article-title":"The Danish National Hospital Register. 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