mode of delivery is not associated with celiac disease

Stine Dydensborg Sander,1,2 Anne Vinkel Hansen,3,4 Ketil Størdal,5,6 Anne-Marie Nybo Andersen,3 Joseph A Murray,7 Steffen Husby1,2 1Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; 2Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; 3Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4Statistics Denmark, Copenhagen, Denmark; 5Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway; 6Department of Pediatrics, Ostfold Hospital Trust, Grålum, Norway; 7Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA Purpose: The purpose of this study was to investigate the association between mode of delivery and the risk of celiac disease in two large population-based birth cohorts with different prevalence of diagnosed celiac disease. Patients and methods: This is an observational register-based cohort study using two independent population cohorts. We used data from administrative registers and health administrative registers from Denmark and Norway and linked the data at the individual level. We included all children who were born in Denmark from January 1, 1995 to December 31, 2010 and all children who were born in Norway from January 1, 2004 to December 31, 2012. Results: We included 1,051,028 children from Denmark. Cesarean sections were registered for 196,512 children (18.9%). Diagnosed celiac disease was registered for 1,395 children (0.13%). We included 537,457 children from Norway. Cesarean sections were registered for 90,128 children (16.8%). Diagnosed celiac disease was registered for 1,919 children (0.35%). We found no association between the mode of delivery and the risk of diagnosed celiac disease. The adjusted odds ratio for celiac disease for children delivered by any type of cesarean section compared to vaginal delivery was 1.11 (95% CI: 0.96–1.29) in the Danish cohort and 0.96 (95% CI: 0.84–1.09) in the Norwegian cohort. The adjusted odds ratio for celiac disease for children delivered by elective cesarean section compared to vaginal delivery was 1.20 (95% CI: 1.00–1.43) in the Danish cohort and 0.96 (95% CI: 0.79–1.17) in the Norwegian cohort. Conclusion: In this large registry-based study, mode of delivery was not associated with an increased risk of diagnosed celiac disease. Keywords: cesarean section, autoimmunity, epidemiology, administrative health register