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Cesarean Section on The Risk of Celiac Disease in the Offspring: The Teddy Study




TekijätSibylle Koletzko, Hye-Seung Lee, Andreas Beyerlein, Carin A. Aronsson, Michael Hummel, Edwin Liu, Ville Simell, Kalle Kurppa, Åke Lernmark, William Hagopian, Marian Rewers, Jin-Xiong She, Olli Simell, Jorma Toppari, Anette-G. Ziegler, Jeffrey Krischer, Daniel Agardh

KustantajaLippincott Williams and Wilkins

Julkaisuvuosi2018

JournalJournal of Pediatric Gastroenterology and Nutrition

Tietokannassa oleva lehden nimiJournal of Pediatric Gastroenterology and Nutrition

Vuosikerta66

Numero3

Aloitussivu417

Lopetussivu424

Sivujen määrä8

ISSN0277-2116

DOIhttps://doi.org/10.1097/MPG.0000000000001682


Tiivistelmä

Objective: Cesarean section (C-section) is associated with various immune-mediated diseases in the offspring. We investigated the relationship between mode of delivery and celiac disease (CD) and CD autoimmunity (CDA) in a multinational birth cohort.

Methods: From 2004 to 2010, infants from the general population who tested positive for HLA DR3-DQ2 or DR4-DQ8 were enrolled in The Environmental Determinants for Diabetes in the Young (TEDDY) study. Children were annually screened for transglutaminase autoantibodies, if positive, they are retested after 3 to 6 months and those persistently positive defined as CDA. Associations of C-section with maternal (age, education level, parity, pre-pregnancy weight, diabetes, smoking, weight gain during pregnancy) and child characteristics (gestational age, birth weight) were examined by Fisher exact test or Wilcoxon rank-sum test. Hazard ratios (HRs) for CDA or CD were calculated by Cox proportional hazard regression models.

Results: Of 6087 analyzed singletons, 1600 (26%) were born by C-section (Germany 38%, United States 37%, Finland 18%, Sweden 16%), and the remaining were born vaginally without instrumental support; 979 (16%) had developed CDA and 343 (6%) developed CD. C-section was associated with lower risk for CDA (hazard ratio [HR] = 0.85; 95% confidence interval [CI] 0.73, 0.99 P = 0.032) and CD (HR = 0.75; 95% CI 0.58, 0.98; P = 0.034). After adjusting for country, sex, HLA-genotype, CD in family, maternal education, and breast-feeding duration, significance was lost for CDA (HR = 0.91; 95% CI 0.78, 1.06; P = 0.20) and CD (HR = 0.85; 95% CI 0.65, 1.11; P = 0.24). Presurgical ruptured membranes had no influence on CDA or CD development.

Conclusion: C-section is not associated with increased risk for CDA or CD in the offspring.



Last updated on 2024-26-11 at 11:41