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Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish
Ulf Samuelsson1, Nina Lindell2, Marie Bladh3
1Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, S-581 85, Linköping, Sweden. ulf.samuelsson@regionostergotland.se.
Insights
Caesarean section (CS) delivery does not increase the risk of type 1 diabetes in children. However, maternal diabetes is a significant risk factor for childhood type 1 diabetes.
Area of Science:
- Pediatrics
- Endocrinology
- Epidemiology
Background:
- Conflicting evidence exists regarding the association between Caesarean section (CS) and the risk of developing type 1 diabetes.
- Understanding this relationship is crucial for public health initiatives and parental counseling.
Purpose of the Study:
- To investigate the association between birth by Caesarean section (CS) and the subsequent risk of developing type 1 diabetes in childhood.
- To determine if maternal diabetes influences the risk of type 1 diabetes in offspring born via CS.
Main Methods:
- A case-control study utilizing the Swedish Paediatric Quality Register.
- Matched 9,376 children diagnosed with type 1 diabetes (2000-2012) with four controls based on birth year, day, sex, and county.
- Logistic regression analysis adjusted for maternal age, maternal diabetes, and pre-pregnancy BMI.
Main Results:
- Overall, 13.5% of deliveries were by CS. Children who developed type 1 diabetes had a slightly higher CS rate (14.7%) compared to controls (13.3%) (p < 0.001).
- After adjusting for confounders, CS delivery showed no increased risk (OR 1.0) for type 1 diabetes in children of mothers without diabetes.
- Maternal diabetes was a strong predictor of childhood type 1 diabetes (OR 3.4), with type 1 diabetes in the mother conferring the highest risk (OR 7.54).
Conclusions:
- Caesarean section (CS) delivery does not independently influence the risk of developing type 1 diabetes in childhood or adolescence.
- Maternal diabetes is a significant risk factor for type 1 diabetes in offspring.
- The findings highlight the importance of maternal health in the context of offspring's risk for type 1 diabetes.
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 = 9,376) 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 13.3% 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.
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