Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies

Abstract

Aims/hypothesis The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders. Methods After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to Diabetologia (2008) 51:726-735

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population‐based cohort study

“…However, other epidemiological studies did not report higher rates of asthma, diabetes type 1, obesity, and inflammatory bowel disease for children born with birth interventions 12, 16. Several studies that included meta‐analyses reported that children born by cesarean delivery were at higher risk of developing obesity, diabetes, or asthma in childhood 4, 6, 30, 31…”

“…Short‐term adverse health outcomes included jaundice, feeding problems, and hypothermia and often are part of the adaptation of the infant to being outside the uterus 7, 27, 28. The longer‐term adverse health outcomes included asthma, respiratory infections (eg, common cold, pneumonia, bronchitis), gastrointestinal disorders, other infections (eg, sepsis, streptococcus, cystitis), metabolic disorder (eg, hypoglycemia, neonatal diabetes mellitus, diabetes mellitus type 1 or 2, localized adiposity), and eczema, based on the potential effect that mode of birth has on immune‐related diseases 5, 6, 7, 12, 13, 14, 15, 16, 17, 18. An overview of all adverse health outcomes and other covariates with corresponding ICD‐10‐AM codes are presented in the Supporting Information.…”

“…Studies have demonstrated that children born vaginally at term have different short‐ and longer‐term physical health outcomes than those born by cesarean, particularly when there has been no exposure 4, 6, 7. Epidemiological studies that analyzed population‐based registry data, reported conflicting associations between operative birth interventions, and the increased risk of several immune‐related diseases, including asthma, type 1 diabetes, obesity, and inflammatory bowel disease 12, 13, 14, 15, 16, 17, 18.…”

Factors associated with caesarean sections in Phnom Penh, Cambodia

“…4,5 C-section can also compromise future pregnancies, and have long term negative effects for the newborns, such as obesity, asthma, type-1 diabetes, and lead to unexplained stillbirths in the second pregnancy. 2,[6][7][8][9][10][11][12] These risks explain why c-section on demand is considered, "an expensive and dangerous luxury". 13 Current evidence strongly advises against unnecessary c-sections.…”

Streptozotocin-induced type-1-diabetes disease onset in Sprague–Dawley rats is associated with an altered intestinal microbiota composition and decreased diversity

“…Many studies have linked alterations in the intestinal microbiota composition with conditions such as obesity (Ley et al, , 2005Murphy et al, 2010;Turnbaugh et al, 2006), inflammatory bowel disease (Greenblum et al, 2012), colitis (Bellavia et al, 2013;Klimesova et al, 2013) and T1D Murri et al, 2013;Roesch et al, 2009). Moreover, risk of T1D onset in childhood is higher in children delivered by Caesarean section (Cardwell et al, 2008), where there is also altered microbiota composition (Dominguez-Bello et al, 2010). Previous studies have examined the role of the intestinal microbiota in the development of T1D but these are often limited due to the models used [i.e.…”