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Updated: Jun 25, 2025
Isolation of Human Islets from Partially Pancreatectomized Patients
Published on: July 30, 2011
Caesarean section and risk of type 1 diabetes
Tarini Singh1, Andreas Weiss1, Kendra Vehik2
1Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
Insights
Caesarean delivery did not increase the risk of developing early-stage type 1 diabetes. However, it was associated with a faster progression to symptomatic stage 3 type 1 diabetes in at-risk children.
Area of Science:
- Endocrinology and Metabolism
- Pediatric Autoimmune Diseases
- Epidemiology of Diabetes
Background:
- Global rates of Caesarean section delivery are increasing.
- Caesarean delivery has been linked to an elevated risk of type 1 diabetes development and progression.
- Understanding the impact of delivery mode on type 1 diabetes progression in at-risk children is crucial.
Purpose of the Study:
- To investigate the association between Caesarean delivery and the progression to stage 3 type 1 diabetes.
- To analyze this association in children with pre-symptomatic early-stage type 1 diabetes.
Main Methods:
- Analysis of 8,135 children from the TEDDY study with genetic predisposition to type 1 diabetes.
- Longitudinal follow-up from birth to monitor for islet autoantibodies and type 1 diabetes development.
- Statistical analysis to determine the association between Caesarean section and disease progression.
Main Results:
- Caesarean section was not associated with an increased risk of developing pre-symptomatic type 1 diabetes.
- Delivery by Caesarean section was linked to a modestly increased rate of progression to stage 3 type 1 diabetes in children with multiple islet autoantibodies.
- Factors associated with higher likelihood of Caesarean delivery included maternal type 1 diabetes, non-singleton births, premature births, birth in the USA, and older maternal age.
Conclusions:
- Caesarean delivery does not elevate the risk of developing early-stage type 1 diabetes.
- Caesarean section is associated with an accelerated progression to symptomatic stage 3 type 1 diabetes in children with pre-symptomatic disease.
- Further research may explore mechanisms linking Caesarean delivery to accelerated type 1 diabetes progression.
Aims/Hypothesis:
Delivery by Caesarean section continues to rise globally and has been associated with the risk of developing type 1 diabetes and the rate of progression from pre-symptomatic stage 1 or 2 type 1 diabetes to symptomatic stage 3 disease. The aim of this study was to examine the association between Caesarean delivery and progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.
Methods:
Caesarean section was examined in 8135 children from the TEDDY study who had an increased genetic risk for type 1 diabetes and were followed from birth for the development of islet autoantibodies and type 1 diabetes.
Results:
The likelihood of delivery by Caesarean section was higher in children born to mothers with type 1 diabetes (adjusted OR 4.61, 95% CI 3.60, 5.90, p<0.0001), in non-singleton births (adjusted OR 4.35, 95% CI 3.21, 5.88, p<0.0001), in premature births (adjusted OR 1.91, 95% CI 1.53, 2.39, p<0.0001), in children born in the USA (adjusted OR 2.71, 95% CI 2.43, 3.02, p<0.0001) and in children born to older mothers (age group >28-33 years: adjusted OR 1.19, 95% CI 1.04, 1.35, p=0.01; age group >33 years: adjusted OR 1.80, 95% CI 1.58, 2.06, p<0.0001). Caesarean section was not associated with an increased risk of developing pre-symptomatic early-stage type 1 diabetes (risk by age 10 years 5.7% [95% CI 4.6%, 6.7%] for Caesarean delivery vs 6.6% [95% CI 6.0%, 7.3%] for vaginal delivery, p=0.07). Delivery by Caesarean section was associated with a modestly increased rate of progression to stage 3 type 1 diabetes in children who had developed multiple islet autoantibody-positive pre-symptomatic early-stage type 1 diabetes (adjusted HR 1.36, 95% CI 1.03, 1.79, p=0.02). No interaction was observed between Caesarean section and non-HLA SNPs conferring susceptibility for type 1 diabetes.
Conclusions/Interpretation:
Caesarean section increased the rate of progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.
Data Availability:
Data from the TEDDY study ( https://doi.org/10.58020/y3jk-x087 ) reported here will be made available for request at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research (R4R) ( https://repository.niddk.nih.gov/ ).
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