Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study

Abstract

Aims/hypothesis Some studies have revealed a relationship between Caesarean section (CS) and type 1 diabetes, while other studies have not. By using the Swedish paediatric quality register we investigated whether birth by CS is related to the risk of developing type 1 diabetes during childhood.Methods All children diagnosed with type 1 diabetes from 2000 to 2012 and included in the register (n=9376) were matched with four controls by year, day of birth, sex and county of birth from the Swedish Medical Birth Register.Results Overall, 13.5% of deliveries were by CS. By group, 14.7% of children who developed type 1 diabetes were delivered by CS compared with 13.5% of control children (p<0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p<0.001). In a logistic regression model adjusting for maternal age, maternal diabetes and BMI in early pregnancy, the OR for CS was 1.0. A child who developed type 1 diabetes and had a mother with type 1 diabetes at the time of delivery had the highest OR to have been born by CS. Children of mothers without diabetes, delivered by CS, had no increased risk of developing type 1 diabetes. Maternal diabetes was the strongest predictor of childhood diabetes (OR 3.4), especially if the mother had type 1 diabetes (OR 7.54).Conclusions/interpretation CS had no influence on the risk of type 1 diabetes during childhood or adolescence. However, maternal diabetes itself strongly increased the risk of offspring developing type 1 diabetes.

The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood‐onset type 1 diabetes mellitus in the offspring: Systematic review and meta‐analysis of observational studies

“…The full text review excluded 71 articles, mostly because the association was not investigated (n = 64; these articles are listed in Appendix S1). A small number of articles (n = 7) were also excluded for various reasons, including studies that were restricted to the enrolment of participants with genetic susceptibility to type 1 diabetes (human leukocyte antigen [HLA]), studies in which the outcome was islet autoimmunity rather than T1DM, a study that only reported the risk of DM, a study in which the onset of T1DM was not reported, or one study that had overlap of the patient population with another included study . Finally, 21 articles were eligible for the final inclusion in the present meta‐analysis.…”

“…was not reported, 37 or one study 38 that had overlap of the patient population with another included study. 19 Finally, 21 articles [18][19][20][21][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] were eligible for the final inclusion in the present meta-analysis.…”

<p>Caesarean Delivery and Risk of Chronic Inflammatory Diseases (Inflammatory Bowel Disease, Rheumatoid Arthritis, Coeliac Disease, and Diabetes Mellitus): A Population Based Registry Study of 2,699,479 Births in Denmark During 1973–2016</p>

“…34 CS, and in particular elective CS has been associated with risk of CIDs in some studies, 22,24,27,32 but not all. 26,28,29 The hypothesis for the present study is that CIDs share a common aetiological component associated with being born by CS and that the risk is higher for elective than planned CS. The aim of the present study was to evaluate the risk of developing CIDs (including four common hospital-diagnosed childhood CIDs) after being born by caesarean delivery, taking advantage of the National Danish registries completeness, size, and long follow-up.…”

“…21 In contrast to planned CS (elective CS), acute CS will often be performed after initiation of the labour, where an open birth canal might potentially give access to the vaginal microbial community. Studies have addressed the risk of developing IBD, [22][23][24][25][26][27] DM, [27][28][29][30] CD, [31][32][33] and RA. 34 CS, and in particular elective CS has been associated with risk of CIDs in some studies, 22,24,27,32 but not all.…”

Currently diagnosed cases of coeliac disease are just the tip of the iceberg

“…This question has also been debated in the pathogenesis of type 1 diabetes, where many studies have shown an increased risk of a child developing the disease if they were delivered by Caesarean section. However, a Swedish study has shown that this risk was only due to the fact that mothers with type 1 diabetes were more likely to have a baby by Caesarean section than mothers without the disease . Caesarean section per se did not increase the risk of a child developing type 1 diabetes and the risk of giving birth to a child who later developed type 1 diabetes was only increased if the mother had the disease herself.…”