TY - JOUR
T1 - Cesarean Section on the Risk of Celiac Disease in the Offspring
T2 - The Teddy Study
AU - for the TEDDY Study Group
AU - Koletzko, Sibylle
AU - Lee, Hye Seung
AU - Beyerlein, Andreas
AU - Aronsson, Carin A.
AU - Hummel, Michael
AU - Liu, Edwin
AU - Simell, Ville
AU - Kurppa, Kalle
AU - Lernmark, Åke
AU - Hagopian, William
AU - Rewers, Marian
AU - She, Jin Xiong
AU - Simell, Olli
AU - She, Jin-Xiong
AU - Ziegler, Anette G.
AU - Krischer, Jeffrey
AU - Agardh, Daniel
AU - Gesualdo, Patricia
AU - Hoffman, Michelle
AU - Karban, Rachel
AU - Norris, Jill
AU - Samper-Imaz, Adela
AU - Steck, Andrea
AU - Waugh, Kathleen
AU - Wright, Hali
AU - Schatz, Desmond
AU - Hopkins, DIane
AU - Steed, Leigh
AU - Thomas, Jamie
AU - Adams, Janey
AU - Silvis, Katherine
AU - Haller, Michael
AU - Gardiner, Melissa
AU - McIndoe, Richard
AU - Sharma, Ashok
AU - McIndoe, Richard A
AU - Sharma, Ashok Kumar
AU - Anderson, Stephen W.
AU - Jacobsen, Laura
AU - Ziegler, Anette G.
AU - Bonifacio, Ezio
AU - Hummel, Sandra
AU - Foterek, Kristina
AU - Janz, Nicole
AU - Kersting, Mathilde
AU - Knopff, Annette
AU - Peplow, Claudia
AU - Roth, Roswith
AU - Scholz, Marlon
AU - Stock, Joanna
N1 - Publisher Copyright:
© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - celiac disease autoimmunity
KW - mode of delivery
KW - screening
KW - tissue transglutaminase
KW - vaginal delivery
UR - http://www.scopus.com/inward/record.url?scp=85026445219&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85026445219&partnerID=8YFLogxK
U2 - 10.1097/MPG.0000000000001682
DO - 10.1097/MPG.0000000000001682
M3 - Article
C2 - 28753178
AN - SCOPUS:85026445219
SN - 0277-2116
VL - 66
SP - 417
EP - 424
JO - Journal of Pediatric Gastroenterology and Nutrition
JF - Journal of Pediatric Gastroenterology and Nutrition
IS - 3
ER -