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The problem
Intervention: Delivery by caesarean section versus vaginal delivery
Who it was tested with: 53,716 mother-child pairs from the Japan Environment and Children's Study, a representative Japanese cohort.
Children or communities are compared with a group that did not receive the intervention, or followed over years. This is the design that best separates what the intervention did from everything else that changed.
"A total of 53,716 mother-child pairs participating in the Japan Environment and Children's Study, a representative Japanese cohort study of children, were included in the analysis of the association between CS and suspected developmental delay, as assessed by the Ages and Stages Questionnaires, Third Edition, in 3-year-old children. Multivariate logistic regression analysis was performed to calculate adjusted odds ratios." The study uses a large representative sample with adjustment for confounders, but the observational design limits causal inference.
Observational design cannot establish causation; reliance on parent-reported questionnaires (Ages and Stages Questionnaires, Third Edition) rather than clinical diagnostic assessment; unmeasured confounding factors may explain associations; cross-sectional analysis at 3 years does not track developmental trajectories over time.
Across countries and designs
1 study · 1 country
