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Caesarean section and risk of type 1 diabetes

Singh, Tarini ; Weiss, Andreas ; Vehik, Kendra LU ; Krischer, Jeffrey ; Rewers, Marian ; Toppari, Jorma ; Lernmark, Åke LU orcid ; Hagopian, William ; Akolkar, Beena and Bonifacio, Ezio , et al. (2024) In Diabetologia
Abstract

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... (More)

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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Diabetologia
publisher
Springer
external identifiers
  • pmid:38819466
ISSN
1432-0428
DOI
10.1007/s00125-024-06176-7
language
English
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yes
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© 2024. The Author(s).
id
a528262d-f501-4615-a94a-f111b85803dc
date added to LUP
2024-06-01 10:20:49
date last changed
2024-06-03 12:39:19
@article{a528262d-f501-4615-a94a-f111b85803dc,
  abstract     = {{<p>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.</p><p>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.</p><p>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&lt;0.0001), in non-singleton births (adjusted OR 4.35, 95% CI 3.21, 5.88, p&lt;0.0001), in premature births (adjusted OR 1.91, 95% CI 1.53, 2.39, p&lt;0.0001), in children born in the USA (adjusted OR 2.71, 95% CI 2.43, 3.02, p&lt;0.0001) and in children born to older mothers (age group &gt;28-33 years: adjusted OR 1.19, 95% CI 1.04, 1.35, p=0.01; age group &gt;33 years: adjusted OR 1.80, 95% CI 1.58, 2.06, p&lt;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.</p><p>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.</p><p>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/ ).</p>}},
  author       = {{Singh, Tarini and Weiss, Andreas and Vehik, Kendra and Krischer, Jeffrey and Rewers, Marian and Toppari, Jorma and Lernmark, Åke and Hagopian, William and Akolkar, Beena and Bonifacio, Ezio and Ziegler, Anette-G and Winkler, Christiane}},
  issn         = {{1432-0428}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Springer}},
  series       = {{Diabetologia}},
  title        = {{Caesarean section and risk of type 1 diabetes}},
  url          = {{http://dx.doi.org/10.1007/s00125-024-06176-7}},
  doi          = {{10.1007/s00125-024-06176-7}},
  year         = {{2024}},
}