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

被引:420
作者
Cardwell, C. R. [1 ]
Stene, L. C. [2 ,3 ]
Joner, G. [3 ,4 ]
Cinek, O. [5 ]
Svensson, J. [6 ]
Goldacre, M. J. [7 ]
Parslow, R. C. [8 ]
Pozzilli, P.
Brigis, G. [9 ]
Stoyanov, D. [10 ]
Urbonaite, B. [11 ]
Sipetic, S. [12 ]
Schober, E. [13 ]
Ionescu-Tirgoviste, C. [14 ]
Devoti, G. [15 ]
de Beaufort, C. E. [16 ]
Buschard, K. [17 ]
Patterson, C. C. [1 ]
机构
[1] Queens Univ Belfast, Sch Med & Dent, Dept Epidemiol & Publ Hlth, Belfast BT12 6BJ, Antrim, North Ireland
[2] Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway
[3] Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway
[4] Univ Oslo, Fac Med, Oslo, Norway
[5] Charles Univ Prague, Sch Med 2, Prague, Czech Republic
[6] Steno Diabet Ctr, DK-2820 Gentofte, Denmark
[7] Univ Oxford, Dept Publ Hlth, Oxford, England
[8] Univ Leeds, Paediat Epidemiol Grp, Leeds, W Yorkshire, England
[9] Riga Stradins Univ, Dept Epidemiol & Publ Hlth, Riga, Latvia
[10] Childrens Diabet Ctr, Sofia, Bulgaria
[11] Kaunas Univ Med, Inst Endocrinol, Kaunas, Lithuania
[12] Univ Belgrade, Sch Med, Inst Epidemiol, Belgrade, Serbia
[13] Med Univ Vienna, Dept Paediat, Vienna, Austria
[14] N Paulescu Inst Diabet, Nutr & Metab Dis Clin, Bucharest, Romania
[15] Univ Lecce, Dept Social Sci & Commun, I-73100 Lecce, Italy
[16] Pediat Clin, Luxembourg, Luxembourg
[17] Rigshosp, Bartholin Inst, DK-2100 Copenhagen, Denmark
关键词
Caesarean section; Cesarean section; diabetes mellitus; epidemiology; type; 1;
D O I
10.1007/s00125-008-0941-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies. Results Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p<0.001). There was little evidence of heterogeneity between studies (p=0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p=0.01). Conclusions/Interpretation This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.
引用
收藏
页码:726 / 735
页数:10
相关论文
共 52 条
[1]   Previous maternal abortion, longer gestation, and younger maternal age decrease the risk of type 1 diabetes among male offspring [J].
Bache, I ;
Bock, T ;
Volund, A ;
Buschard, K .
DIABETES CARE, 1999, 22 (07) :1063-1065
[2]   Traditional reviews, meta-analyses and pooled analyses in epidemiology [J].
Blettner, M ;
Sauerbrei, W ;
Schlehofer, B ;
Scheuchenpflug, T ;
Friedenreich, C .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 1999, 28 (01) :1-9
[3]  
BLOM L, 1989, DIABETOLOGIA, V32, P7
[4]   Secular trends, disease maps and ecological analyses of the incidence of childhood onset type 1 diabetes in Northern Ireland, 1989-2003 [J].
Cardwell, C. R. ;
Carson, D. J. ;
Patterson, C. C. .
DIABETIC MEDICINE, 2007, 24 (03) :289-295
[5]   Parental age at delivery, birth order, birth weight and gestational age are associated with the risk of childhood Type 1 diabetes: a UK regional retrospective cohort study [J].
Cardwell, CR ;
Carson, DJ ;
Patterson, CC .
DIABETIC MEDICINE, 2005, 22 (02) :200-206
[6]   MATERNAL-CHILD BLOOD-GROUP INCOMPATIBILITY AND OTHER PERINATAL EVENTS INCREASE THE RISK FOR EARLY-ONSET TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS [J].
DAHLQUIST, G ;
KALLEN, B .
DIABETOLOGIA, 1992, 35 (07) :671-675
[7]   Perinatal risk factors for childhood type 1 diabetes in Europe - The EURODIAB substudy 2 study group [J].
Dahlquist, GG ;
Patterson, C ;
Soltesz, G .
DIABETES CARE, 1999, 22 (10) :1698-1702
[8]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[9]   Socioeconomic conditions and type 1 diabetes in childhood in North Rhine-Westphalia, Germany [J].
du Prel, J. -B. ;
Icks, A. ;
Grabert, M. ;
Holl, R. W. ;
Giani, G. ;
Rosenbauer, J. .
DIABETOLOGIA, 2007, 50 (04) :720-728
[10]   Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis [J].
Duval, S ;
Tweedie, R .
BIOMETRICS, 2000, 56 (02) :455-463