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Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study
Department of Medicine, Örebro University Hospital, Örebro University, Örebro, Sweden.
Clinical Epidemiology Unit and Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit and Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
Division of Gastroenterology and Hepatology, Departments of Medicine and Immunology, Mayo Clinic College of Medicine, Rochester MN, USA.
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2012 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 142, no 1, p. 39-45.e3Article in journal, Editorial material (Refereed) Published
Abstract [en]

Background & Aims: 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.

Methods: 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.

Results: We found a positive association between elective cesarean delivery and later celiac disease (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.26), but no increased risk of celiac disease after emergency (adjusted OR, 1.02; 95% CI, 0.92-1.13) or any cesarean delivery (adjusted OR, 1.06; 95% CI, 0.99-1.13). Infants born small for gestational age were at a 21% increased risk of celiac disease (95% CI, 1.09-1.35), whereas other pregnancy exposures did not increase the risk of future celiac disease.

Conclusions: 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.

Place, publisher, year, edition, pages
Philadelphia, USA: Saunders Elsevier, 2012. Vol. 142, no 1, p. 39-45.e3
Keywords [en]
Cesarean Section, Prematurity, Register
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-21404DOI: 10.1053/j.gastro.2011.09.047ISI: 000298250800027PubMedID: 21995948Scopus ID: 2-s2.0-83755172194OAI: oai:DiVA.org:oru-21404DiVA, id: diva2:485773
Note

Funding Agency:

NIDDK NIH HHS DK057892  DK071003  R01 DK057892  R01 DK057892-05  R01 DK071003  R01 DK071003-02  R56 DK071003

Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2018-07-22Bibliographically approved
In thesis
1. Risc factors and associated disorders of celiac disease
Open this publication in new window or tab >>Risc factors and associated disorders of celiac disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Celiac disease (CD) is an immune-mediated enteropathy induced by dietary gluten. CD is prevalent in some 1 % of the general population. In recent decades there has been a marked increase in CD prevalence that may be influenced by environmental risk factors.

Aims: The aim of this thesis was to examine possible risk factors for CD and to gain information on associated disorders of CD.

Methods: In study I we used regional cohort-data from ~11,000 children to examine the association between psychological stress in early life and subsequent CD. In studies II-IV we used nationwide histopathology data to identify individuals with CD (i.e. villous atrophy). In study II we linked data on ~29,000 CD patients to the National patient register to examine the risk of hospital admission for influenza. In studies III-IV we linked data on ~11,000 CD patients to several Swedish registries, including the Medical birth register, to examine neonatal risk factors in CD (study III) and the risk of CD in patients with Down syndrome (study IV).

Results: Psychological stress in the first years of life was not associated with subsequent CD. We found a two-fold increased risk of hospital admission for influenza in patients with CD (95 % confidence interval [CI] = 1.6-2.7).While elective cesarean delivery was associated with an increased risk of later CD (adjusted Odds Ratio [OR] = 1.15; 95 % CI = 1.04-1.26), emergency cesarean delivery was not (adjusted OR = 1.02; 95 % CI = 0.92-1.13). Finally, in study IV we found a six-fold increased risk of CD in children with Down syndrome (95 % CI = 5.09-7.43).

Conclusion: This thesis supports the hypothesis that certain environmental risk factors, such as mode of delivery, but possibly not early psychological stress, influence the risk of CD. The increased risk of hospital admission for influenza indicate that individuals with CD may benefit from influenza immunization. The highly increased risk of CD in Down syndrome supports CD screening in Down syndrome patients.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 102
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 68
Keywords
Celiac disease, cohort study, Down syndrome, influenza, pediatrics, population-based, pregnancy outcome, psychological stress, registry
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-22136 (URN)978-91-7668-865-6 (ISBN)
Public defence
2012-05-25, Wilandersalen, Universitetssjukhuset i Örebro, Örebro, 13:30 (Swedish)
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Available from: 2012-03-16 Created: 2012-03-16 Last updated: 2017-10-17Bibliographically approved

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