Caesarean section, a surgical procedure to deliver babies, can be a life-saving intervention but its increasing use globally has caused some concerns as it may lead to short- and long-term health effects for women and children. It has been hypothesised that delivery method may have an impact on cognitive development, possibly because caesarean section alters the colonisation and composition of early life gut microbiota. Evidence suggests that gut microbiota is linked to early brain development and may influence later cognitive outcomes. This study aimed to investigate whether caesarean section is associated with NCEA Level 2 Percentile Score, Level 2 Highest Endorsement and University Entrance attainment, which are markers of cognitive development. We used New Zealand population level administrative data, obtained from the New Zealand Integrated Data Infrastructure, to answer three research questions central to advancing our understanding of the association between mode of delivery and secondary school educational outcomes: 1. Is there an association between caesarean section delivery and educational outcomes measured at high school? 2. Is there an association between caesarean section delivery and educational outcomes measured at high school after adjusting for confounder variables? 3. Is there an association between caesarean section delivery and educational outcomes measured at high school after further controlling for family-wide influences and genetic factors? This study comprised four analytical stages: bivariate analysis, covariate-adjusted analysis, sibling fixed effects analysis and stratified and sensitivity analyses. We found that the associations were not significant in either the covariate-adjusted or the sibling fixed effects analyses. Our results suggested that caesarean section does not impact on children’s educational achievements in the long term.
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