TY - JOUR
T1 - Pregnancy outcome and risk of celiac disease in offspring
T2 - A nationwide case-control study
AU - Mårild, Karl
AU - Stephansson, Olof
AU - Montgomery, Scott
AU - Murray, Joseph A.
AU - Ludvigsson, Jonas F.
N1 - Funding Information:
Funding Supported by the Swedish Society of Medicine (K.M., O.S., and J.F.L.); the National Institutes of Health (grants DK071003 and DK057892 to J.A.M.); the Swedish Research Council, the Sven Jerring Foundation, the Örebro Society of Medicine, the Karolinska Institutet, the Clas Groschinsky Foundation, the Juhlin Foundation, the Majblomman Foundation, Uppsala-Örebro Regional Research Council, and the Swedish Celiac Society (J.F.L.).
PY - 2012/1
Y1 - 2012/1
N2 - Studies on pregnancy characteristics and mode of delivery and risk of later celiac disease in offspring are inconsistent. In recent decades rates of cesarean delivery and preterm birth survival have increased while at the same time the prevalence of celiac disease has doubled. In this population-based case-control study we examined the risk of celiac disease in individuals exposed to cesarean delivery and adverse fetal events (ie, low Apgar score, small for gestational age, low birth weight, preterm birth, and neonatal infections). Prospectively recorded pregnancy data were obtained from the Swedish Medical Birth Register between 1973 and 2008. Study participants consisted of 11,749 offspring with biopsy-verified celiac disease identified through histopathology reports from Sweden's 28 pathology departments, and 53,887 age- and sex-matched controls from the general population. We found a positive association between elective cesarean delivery and later celiac disease (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.041.26), but no increased risk of celiac disease after emergency (adjusted OR, 1.02; 95% CI, 0.921.13) or any cesarean delivery (adjusted OR, 1.06; 95% CI, 0.991.13). Infants born small for gestational age were at a 21% increased risk of celiac disease (95% CI, 1.091.35), whereas other pregnancy exposures did not increase the risk of future celiac disease. The positive association with elective, but not emergency, cesarean delivery is consistent with the hypothesis that the bacterial flora of the newborn plays a role in the development of celiac disease.
AB - Studies on pregnancy characteristics and mode of delivery and risk of later celiac disease in offspring are inconsistent. In recent decades rates of cesarean delivery and preterm birth survival have increased while at the same time the prevalence of celiac disease has doubled. In this population-based case-control study we examined the risk of celiac disease in individuals exposed to cesarean delivery and adverse fetal events (ie, low Apgar score, small for gestational age, low birth weight, preterm birth, and neonatal infections). Prospectively recorded pregnancy data were obtained from the Swedish Medical Birth Register between 1973 and 2008. Study participants consisted of 11,749 offspring with biopsy-verified celiac disease identified through histopathology reports from Sweden's 28 pathology departments, and 53,887 age- and sex-matched controls from the general population. We found a positive association between elective cesarean delivery and later celiac disease (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.041.26), but no increased risk of celiac disease after emergency (adjusted OR, 1.02; 95% CI, 0.921.13) or any cesarean delivery (adjusted OR, 1.06; 95% CI, 0.991.13). Infants born small for gestational age were at a 21% increased risk of celiac disease (95% CI, 1.091.35), whereas other pregnancy exposures did not increase the risk of future celiac disease. The positive association with elective, but not emergency, cesarean delivery is consistent with the hypothesis that the bacterial flora of the newborn plays a role in the development of celiac disease.
KW - Cesarean Section
KW - Prematurity
KW - Register
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U2 - 10.1053/j.gastro.2011.09.047
DO - 10.1053/j.gastro.2011.09.047
M3 - Article
C2 - 21995948
AN - SCOPUS:83755172194
SN - 0016-5085
VL - 142
SP - 39-45.e3
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -