The sequential use of vacuum extraction followed by forceps during childbirth is associated with a heightened risk of attention-deficit/hyperactivity disorder (ADHD) in children compared to delivery via second-stage cesarean section, according to a study published January 30, 2026.
Researchers analyzed medical records from over 500,000 full-term births in British Columbia between 2000 and 2019, tracking children for up to 22 years. The study, published in JAMA Network Open, compared neurodevelopmental outcomes across different birthing techniques, including spontaneous vaginal delivery, vacuum-assisted delivery, forceps-assisted delivery, second-stage cesarean sections, and combinations of vacuum and forceps.
The data revealed that children delivered using both vacuum and forceps experienced an ADHD diagnosis rate of 7.9 per 1,000 person-years, while those delivered by second-stage cesarean had a rate of 6.6 per 1,000 person-years, according to findings reported by pvcnr.com. The study, led by Maya Rajasingham of McMaster University and Sarka Lisonkova of the University of British Columbia, also indicated a higher risk of intellectual disability following vacuum delivery compared to cesarean delivery, though the differences were described as compact overall.
While forceps delivery alone did not demonstrate a significant increase in risk, the sequential application of vacuum extraction followed by forceps presented the most pronounced association with ADHD. Rates of autism spectrum disorder did not vary substantially based on delivery type.
Medical professionals caution against altering current labor management practices based solely on these findings. Dr. Andrea Edlow of Massachusetts General Hospital, who was not involved in the research, emphasized the primacy of addressing immediate risks to both mother and newborn during labor, as reported by pvcnr.com.
The study’s authors, including Maya Rajasingham, Neda Razaz, and Giulia M Muraca, accepted the research for publication on December 5, 2025. The research team is exploring potential mechanisms underlying the observed associations, including physical trauma during assisted delivery, alterations in cerebral blood flow, and the impact of labor stress on fetal development.
Medscape Medical News reported that the study adds to a growing body of research examining the link between childbirth interventions and long-term neurodevelopmental outcomes. A separate study, also reported in January 2026, found that cesarean deliveries were associated with a 33% increased risk of autism spectrum disorder (ASD) and a 17% increased risk of ADHD, though researchers stress that association does not equal causation.
