Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children

Abstract

The postnatal period represents a particularly dynamic phase in the establishment of the host-microbial homeostasis. The sterile protected intestinal mucosa of the fetus becomes exposed to and subsequently colonized by a complex and diverse bacterial community. Both, the exposure to microbial ligands and the bacterial colonization have been described to differ between neonates born vaginally or by cesarean delivery. These differences might influence the development of the mucosal immune system, the establishment of a stable intestinal host-microbial homeostasis, and ultimately contribute to the risk to acquire immune mediated diseases later in life. Indeed, an increased risk for atopic diseases such as allergic rhinitis and asthma was reported in children born by cesarean delivery. Our recent study described an association between cesarean delivery and celiac disease. Here we summarize the available information on postnatal microbial colonization and the influence of the mode of delivery on flora composition and host microbial homeostasis. We discuss possible consequences of the mode of delivery on epithelial barrier function and the establishment of the mucosal immune system and speculate on functional links between flora alterations and the development of inappropriate host immune responses that may contribute to enteric inflammatory diseases.

Season of birth in a nationwide cohort of coeliac disease patients

“…In 1987, Kagnoff et al suggested that adenovirus may play a role in the pathogenesis of CD,12 and prior rotavirus infection increases the risk of developing CD13 but not active infection 14. A recent German study found that earlier gastrointestinal disease (including both infections and non-infectious disease) increased the risk of later CD,15 while our group found a non-significantly increased risk of CD in children with an infection at the time of gluten introduction 8. Recently we also showed that elective caesarean section is associated with later CD 16.…”

The Intestinal Microbiome in Early Life: Health and Disease

“…Additionally, by age 11 these children were 1.83 times more likely to be overweight or obese (65). Furthermore, Decker et al found that children born by cesarean section also have an enhanced risk for developing celiac disease (66). Gut microbial dysbiosis has been the most accepted explanation for the association of delivery mode with disease outcome, but more research is needed to adequately support these hypotheses, as these remain as association studies.…”

The Host Microbiome Regulates and Maintains Human Health: A Primer and Perspective for Non-Microbiologists

“…During infancy, the impact of alterations in community assembly on function has been linked to outcomes such as malnourishment, C. difficile -associated diarrhea, and necrotizing enterocolitis (74,76,77). Early life microbiome disruption may potentially increase risk for developing celiac disease, asthma, type-1 diabetes, and obesity (70,72,78-81). These conditions could have long-term medical implications that interact reciprocally with the gut microbiome.…”