Cardwell C R, Stene L C, Joner G, Cinek O, Svensson J, Goldacre M J, Parslow R C, Pozzilli P, Brigis G, Stoyanov D, Urbonaite B, Sipetić S, Schober E, Ionescu-Tirgoviste C, Devoti G, de Beaufort C E, Buschard K, Patterson C C
Department of Epidemiology and Public Health, School of Medicine and Dentistry, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
Diabetologia. 2008 May;51(5):726-35. doi: 10.1007/s00125-008-0941-z. Epub 2008 Feb 22.
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.
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.
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.
目的/假设：本研究旨在通过系统回顾已发表的文献并进行调整公认混杂因素的荟萃分析，来调查剖宫产出生儿童患儿童期1型糖尿病风险增加的证据。
在检索MEDLINE、科学网和EMBASE之后，根据每项研究报告的数据计算剖宫产出生儿童患1型糖尿病的粗OR值和95%CI。联系作者以促进对潜在混杂因素的调整，方法是提供原始数据或计算调整后的估计值。然后使用荟萃分析技术得出合并OR值，并调查研究之间的异质性。
共识别出20项研究。总体而言，剖宫产出生儿童患1型糖尿病的风险显著增加（OR 1.23，95%CI 1.15 - 1.32，p < 0.001）。研究之间几乎没有异质性证据（p = 0.54）。17位作者提供了原始数据或调整后的估计值，以促进对潜在混杂因素的调整。在这些研究中，有证据表明糖尿病风险随着出生体重增加、孕周缩短和母亲年龄增大而增加。在调整孕周、出生体重、母亲年龄、出生顺序、母乳喂养和母亲糖尿病后，剖宫产术后1型糖尿病风险增加的幅度变化不大（调整后OR 1.19，95%CI 1.04 - 1.36，p = 0.01）。
结论/解读：该分析表明，剖宫产分娩后患儿童期1型糖尿病的风险增加了20%，这无法用已知的混杂因素来解释。
