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Breech Delivery and Intelligence: A Population-Based Study of 8,738 Breech Infants

Martha G. Eide, MD^*, Nina Øyen, MD, MPH^*, Rolv Skjærven, PhD^*, Lorentz M. Irgens, MD, PhD^*, Tor Bjerkedal, MD, PhD and Stein Tore Nilsen, MD, PhD^¶

From the *Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Norway; The Medical Birth Registry of Norway, Locus of Registry Based Epidemiology, University of Bergen, and Norwegian Institute of Public Health; Section of Military Medicine Research and Development, Headquarters of Defense, Norway; Rogaland Central Hospital, Norway; and ¶Section for Obstetrics and Gynecology, Department of Clinical Medicine, University of Bergen, Norway.

Address reprint requests to: Martha Gunn Eide, Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway; e-mail: martha.eide{at}mfr.uib.no.

OBJECTIVE: Long-term intellectual performance in breech-presented infants may be negatively affected by vaginal delivery. We evaluated the effect of presentation at birth and delivery mode on intellectual performance at age 18 years in a nationwide population study.

METHODS: We studied 8,738 male infants in breech and 384,832 males in cephalic presentation registered in the Medical Birth Registry of Norway, 1967–1979, and linked to data registered at the National Conscript Service, 1984–1999. Test scores of intelligence testing at conscription were presented as standard nine ("stanine") scores. Mean stanine scores and odds ratios of low score were computed and adjusted for birth order, maternal age, and education.

RESULTS: Mean stanine score was slightly higher among breech-presented males than among cephalic-presented males (5.26 versus 5.22, P = .05), whereas after adjustment the difference disappeared (P = .3). Breech-presented infants had lower mean scores if delivered by cesarean compared with vaginal breech delivery (P = .03), and cephalic-presented males scored lower if their mothers had a cesarean delivery instead of a vaginal delivery (P < .001). Comparing cesarean and vaginal delivery in breech births, the odds ratio of having a stanine score less than or equal to 3 was 1.12 (95% confidence interval 0.92,1.36), after adjustment for confounding factors.

CONCLUSION: Presentation at birth did not affect adult intellectual performance. Cesarean delivery of breech-presented infants did not improve adult intellectual performance when compared with a vaginal delivery. The excess perinatal hazards of breech-presented infants with a vaginal delivery were not reflected in adult intellectual performance.

LEVEL OF EVIDENCE: II-2

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				Other articles noted Evid. Based Med., August 1, 2005; 10(4): 127 - 128. [Full Text] [PDF]