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Cesarean delivery and risk of hospitalization for autoimmune disorders before 14 years of age

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Abstract

It is supposed that cesarean birth is implicated in the development of autoimmunity. We evaluated the association between cesarean delivery and the risk of hospitalization for autoimmune disease in children up to 14 years of age. We performed a longitudinal cohort study of 934,873 children born between 2006 and 2019 in Quebec, Canada. The main exposure measure was cesarean delivery versus vaginal delivery (spontaneous or induced). Outcomes included hospitalization for type 1 diabetes, celiac disease, or other autoimmune disorders before 14 years of age. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between cesarean delivery and hospitalization for autoimmune disorders, adjusted for patient characteristics. A total of 248,963 children (27%) were delivered by cesarean. Median length of follow-up was 7.4 years. The hospitalization rate for autoimmune disorders was 69.1 per 100,000 person-years for cesarean and 65.9 per 100,000 person-years for vaginal delivery. Cesarean delivery was not associated with autoimmune disorders overall (HR 1.02, 95% CI 0.96–1.10). There was no association with type 1 diabetes (HR 1.00, 95% CI 0.85–1.17), celiac disease (HR 0.86, 95% CI 0.71–1.04), inflammatory bowel disease (HR 1.15, 95% CI 0.88–1.49), or idiopathic thrombocytopenic purpura (HR 1.01, 95% CI 0.82–1.25). Cesarean delivery was not associated with autoimmune disorders at different ages.

Conclusion: This study suggests that cesarean delivery is not associated with the risk of hospitalization for autoimmune disorders before 14 years of age. Delivery mode does not seem to mediate the risk of autoimmunity in childhood.

What is Known:

• Children born by cesarean may be at risk of abnormal immune development.

• The association between cesarean delivery and risk of pediatric autoimmune disorders is unclear.

What is New:

• In this cohort study of over 900,000 children, cesarean delivery was not associated with the risk of hospitalization for a range of autoimmune disorders before 14 years of age.

• Cesarean delivery may not be related to the development of autoimmunity.

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Data availability

The data that support the findings of this study are available upon request from the Institut de la statistique du Québec, following standard access procedures.

Abbreviations

CI:

Confidence interval

HR:

Hazard ratio

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Code availability

Statistical code is available from the authors upon request.

Funding

This research was funded by the Canadian Institutes of Health Research (PCC-170244) and the Fonds de recherche du Québec-Santé (34695).

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Authors and Affiliations

Authors

Contributions

SS interpreted the results, wrote the preliminary version of the manuscript, and gave final approval of the version to be submitted.

MH contributed to study conception and design, interpretation of results, critical appraisal of the manuscript for intellectual content, and gave final approval of the version to be submitted.

HK helped interpret the results, critically appraised the manuscript for intellectual content, and gave final approval of the version to be submitted.

TML contributed to the conception and design of the study, helped interpret the results, critically appraised the manuscript for intellectual content, and gave final approval of the version to be submitted.

GL analyzed the data, helped interpret the results and write the preliminary version of the manuscript, and gave final approval of the version to be submitted.

NA contributed to the conception and design of the study, acquired the data, supervised the data analysis and manuscript writing, and gave final approval of the version to be submitted.

Corresponding author

Correspondence to Nathalie Auger.

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Ethics approval and consent to participate

Data used in this study were de-identified, and informed consent was not required. The ethics board of the University of Montreal Hospital Centre waived the need for ethics approval. The study was performed in accordance with the Declaration of Helsinki.

Consent for publication

Data used in this study were de-identified, and consent for publication was not required.

Conflict of interest

The authors declare no competing interests.

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Communicated by Gregorio Paolo Milani

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Soullane, S., Henderson, M., Kang, H. et al. Cesarean delivery and risk of hospitalization for autoimmune disorders before 14 years of age. Eur J Pediatr 180, 3359–3366 (2021). https://doi.org/10.1007/s00431-021-04132-w

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  • DOI: https://doi.org/10.1007/s00431-021-04132-w

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