Caesarean section and risk of type 1 diabetes

DiabetologiaPublished 31 May 2024Prospective cohort study

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Authors' conclusion

Caesarean section increased the rate of progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.

Study context

Population: Children from the TEDDY study with increased genetic risk for T1D, followed from birth for islet autoantibodies and T1D
Participants: 8,135 children

Exposure: Caesarean section vs vaginal delivery
Outcome: Progression to stage 3 T1D in children with pre-symptomatic early-stage T1D

Methodological detailssecondary analysis of the TEDDY study, followed from birth

As reported in the abstract

Rate of progression to stage 3 T1D in children with multiple islet autoantibody-positive pre-symptomatic early-stage T1D

Adjusted hazard ratio

1.36

95% CI 1.03–1.79

P = 0.02

Caesarean deliveryvs Vaginal delivery

aHR 1.36 (95% CI 1.03–1.79); P = 0.02

Observational data: associations, not effects.

Outcome	Caesarean delivery	Vaginal delivery	P value
Risk of developing pre-symptomatic early-stage T1D · by age 10 yearsNot associated with increased risk	5.7% (CI 4.6%–6.7%)	6.6% (CI 6.0%–7.3%)	P = 0.07

Factors associated with Caesarean delivery

Mother with T1D, aOR: 4.61 (95% CI 3.60, 5.90; p<0.0001)
Non-singleton births, aOR: 4.35 (95% CI 3.21, 5.88; p<0.0001)
Premature births, aOR: 1.91 (95% CI 1.53, 2.39; p<0.0001)
Born in the USA, aOR: 2.71 (95% CI 2.43, 3.02; p<0.0001)
Maternal age >28-33 years, aOR: 1.19 (95% CI 1.04, 1.35; p=0.01)
Maternal age >33 years, aOR: 1.80 (95% CI 1.58, 2.06; p<0.0001)

Interaction with non-HLA susceptibility SNPs

No interaction between Caesarean section and non-HLA SNPs conferring T1D susceptibility

Caesarean section and risk of type 1 diabetes. Diabetologia. Published 31 May 2024. doi:10.1007/s00125-024-06176-7

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