別慌，科學(xué)家還沒有發(fā)現(xiàn)剖腹產(chǎn)會(huì)導(dǎo)致自閉癥

Few fields of medical research attract controversy quite like those associated with childbirth and the risk of developmental disorders. Combined, it's a sensitive topic primed for a heated debate.

很少有醫(yī)學(xué)研究領(lǐng)域像那些與分娩和發(fā)育障礙風(fēng)險(xiǎn)相關(guān)的研究那樣引起爭議?？傊@是一個(gè)敏感的話題，將引發(fā)一場激烈的辯論。

A recent review linking caesarean section deliveries with autism could be interpreted as a reason to push for a vaginal birth instead. But despite the impressive appearance of the meta-study's numbers, some experts argue it falls short of warranting advice for expectant mothers.

最近的一篇綜述將剖腹產(chǎn)與自閉癥聯(lián)系起來，這可以被解釋為推動(dòng)順產(chǎn)的一個(gè)原因。然而，盡管這項(xiàng)薈萃研究的數(shù)據(jù)令人印象深刻，但一些專家認(rèn)為，它并沒有為孕婦提供充分的建議。

Scientists from Swedish and Spanish research institutes compiled data on a whopping 20 million caesarean and vaginal deliveries recorded in 61 observational studies, some of which were conducted as far back as the 1960s.

瑞典和西班牙研究機(jī)構(gòu)的科學(xué)家收集了61項(xiàng)觀察性研究中記錄的2000萬例剖腹產(chǎn)和陰道分娩的數(shù)據(jù)，其中一些研究早在20世紀(jì)60年代就開始了。

Their results suggest children delivered by C-section have a 1.33 times greater risk of falling on the autism spectrum, compared with children delivered vaginally. They also found similar numbers regarding the development of attention deficit disorder, finding 1.17 times increased risk for those delivered via C-section.

他們的研究結(jié)果表明，剖腹產(chǎn)的孩子患自閉癥的風(fēng)險(xiǎn)是順產(chǎn)孩子的1.33倍。他們還發(fā)現(xiàn)，在注意力缺陷障礙的發(fā)展方面也有類似的數(shù)據(jù)，通過剖腹產(chǎn)分娩的風(fēng)險(xiǎn)增加了1.17倍。

To most parents, any chance that their unborn child could face more hardship than necessary is reason to take notice. But amid emotional debates over whether caesarean deliveries lead to fatter babies or give babies the right kind of microbes, mothers already face intense judgement over their choice of birthing method.

對大多數(shù)父母來說，他們未出生的孩子可能會(huì)面臨比需要更多的困難，這是值得注意的原因。但是，在關(guān)于剖腹產(chǎn)是否會(huì)導(dǎo)致更胖的嬰兒或給嬰兒合適的微生物的情感爭論中，母親們在選擇分娩方法時(shí)已經(jīng)面臨著激烈的判斷。

Knowing there is a chance of an increased risk is all well and good. Understanding how it should affect our decisions is something else entirely.

知道風(fēng)險(xiǎn)有增加的可能是件好事。理解它應(yīng)該如何影響我們的決定完全是另一回事。

University of Queensland obstetrics researcher Gino Pecoraro sees the significance of this kind of research in making sound decisions.

昆士蘭大學(xué)產(chǎn)科研究員吉諾·佩科拉羅認(rèn)為，這種研究對于做出正確的決定具有重要意義。

"Before undergoing any treatment, particularly elective treatment, it is important that doctors make patients aware of the options they have and their potential risks and benefits," says Pecoraro.

佩科拉羅說：“在接受任何治療，特別是選擇性治療之前，醫(yī)生必須讓患者知道他們的選擇以及潛在的風(fēng)險(xiǎn)和益處。”

But he's also concerned about reading too much into the study's conclusions.

但他也擔(dān)心對研究結(jié)論的解讀太多。

Calculating the chances any one child will be diagnosed with autism spectrum disorder is easier said than done. That figure could be as low as 0.6 percent in some parts of the world. The CDC estimates it could be as high as 1.69 percent.

計(jì)算任何一個(gè)孩子被診斷為自閉癥譜系障礙的可能性，說起來容易做起來難。在世界某些地區(qū)，這個(gè)數(shù)字可能低至0.6%。疾病預(yù)防控制中心的估計(jì)，可能高達(dá)1.69%。

If we use the CDC estimate, the absolute risk of autism increases just a little to 2.24 percent for C-section births, according to this latest research. Not only does this put a small jump in risk into perspective, it also reflects the difficulties in defining disorders like autism with consistency.

如果我們使用疾控中心的估計(jì)，根據(jù)最新的研究，剖腹產(chǎn)嬰兒患自閉癥的絕對風(fēng)險(xiǎn)只增加了一點(diǎn)點(diǎn)，達(dá)到2.24%。這不僅使人們對風(fēng)險(xiǎn)有了一個(gè)小的飛躍，也反映出在一致性地定義自閉癥等疾病方面的困難。

Pecoraro points out changes to the way researchers have diagnosed such disorders over time complicates research. While tens of millions of data samples seems impressive, it could be a problem if they don't agree on how autism should be defined.

佩科拉羅指出，隨著時(shí)間的推移，研究人員診斷這類疾病的方式發(fā)生了變化，這使得研究變得復(fù)雜。雖然數(shù)以千萬計(jì)的數(shù)據(jù)樣本似乎令人印象深刻，但如果他們不同意如何定義自閉癥，這可能是個(gè)問題。

It might not be enough to dismiss the study outright, but Pecoraro does urge caution in reading too deeply into its results.

這可能還不足以徹底否定這項(xiàng)研究，但佩科拉羅確實(shí)敦促人們謹(jǐn)慎對待研究結(jié)果。

"This study is certainly interesting and begs further prospective research be undertaken to try and answer the question of whether delivery by caesarean section increases the burden of mental health issues in children," he says.

他說：“這項(xiàng)研究當(dāng)然很有趣，并要求進(jìn)行進(jìn)一步的前瞻性研究，試圖回答剖腹產(chǎn)是否會(huì)增加兒童心理健康問題的負(fù)擔(dān)這一問題。”

"Ultimately, this study does not answer this question, but merely comes up with the correct recommendation that 'further research is required'."

“最終，這項(xiàng)研究并沒有回答這個(gè)問題，只是提出了‘需要進(jìn)一步研究’的正確建議。”

It goes without saying that future investigations will build or shake confidence in the findings. But as controversial as the study might be, it's far from the first to identify a link.

不用說，未來的調(diào)查將建立或動(dòng)搖人們對調(diào)查結(jié)果的信心。盡管這項(xiàng)研究可能存在爭議，但它遠(yuǎn)不是第一個(gè)確定兩者之間存在關(guān)聯(lián)的研究。

The question over whether a correlation exists isn't what concerns so many researchers. It's that without clearer evidence of a mechanism, it's hard to judge any single preference for a caesarean delivery over a vaginal one given both come with serious risks and benefits.

關(guān)于相關(guān)性是否存在的問題并不是那么多研究人員關(guān)心的問題。這是因?yàn)椋绻麤]有更明確的機(jī)制證據(jù)，很難判斷剖腹產(chǎn)比陰道分娩的任何一種偏好，因?yàn)閮烧叨季哂忻黠@的風(fēng)險(xiǎn)和好處。