Caesarean Section on The Risk of Celiac Disease in the Offspring: The Teddy Study

Research output: Contribution to journalArticle


title = "Caesarean Section on The Risk of Celiac Disease in the Offspring: The Teddy Study",
abstract = "OBJECTIVE:: Caesarean 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 re-tested after 3–6 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 Fisherʼs exact test or Wilcoxon rank-sum test. Hazard ratios (HRs) for CDA or CD were calculated by Cox proportional hazard regression models. RESULTS:: Of 6,087 analyzed singletons 1600 (26%) were born by C-section (Germany 38%, US 37%, Finland 18%, Sweden 16%), the remaining vaginally without instrumental support; 979 (16%) had developed CDA and 343 (6%) CD. C-section was associated with lower risk for CDA (HR?=?0.85, [95% 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 breastfeeding 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). Pre-surgical 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.",
author = "Sibylle Koletzko and Hye-Seung Lee and Andreas Beyerlein and Aronsson, {Carin A.} and Michael Hummel and Edwin Liu and Ville Simell and Kalle Kurppa and {\AA}ke Lernmark and William Hagopian and Marian Rewers and Jin-Xiong She and Olli Simell and Jorma Toppari and Ziegler, {Anette G.} and Jeffrey Krischer and Daniel Agardh and {TEDDY Study Group}",
year = "2018",
doi = "10.1097/MPG.0000000000001682",
language = "English",
volume = "66",
pages = "417--424",
journal = "Journal of Pediatric Gastroenterology and Nutrition - Jpgn",
issn = "1536-4801",
publisher = "Lippincott Williams & Wilkins",
number = "3",