分娩前剖宫产与儿童1型糖尿病风险：一项基于全国登记处的队列研究
Prelabor Cesarean Section and Risk of Childhood Type 1 Diabetes: A Nationwide Register-based Cohort Study.
作者信息
Clausen Tine Dalsgaard, Bergholt Thomas, Eriksson Frank, Rasmussen Steen, Keiding Niels, Løkkegaard Ellen C
机构信息
From the aDepartment of Gynecology and Obstetrics, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark; bSection of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and cDepartment of Microbiology, Hvidovre Hospital, Copenhagen, Denmark.
出版信息
Epidemiology. 2016 Jul;27(4):547-55. doi: 10.1097/EDE.0000000000000488.
BACKGROUND
Unfavorable conditions associated with cesarean section may influence the risk of type 1 diabetes in offspring, but results from studies are conflicting. We aimed to evaluate the association between prelabor cesarean section and risk of childhood type 1 diabetes.
METHODS
A Danish nationwide cohort study followed all singletons born during 1982-2010. Four national registers provided information on mode of delivery, outcome, and confounders. The risk of childhood type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 1,760,336 singletons contributed 20,436,684 person-years, during which 4,400 were diagnosed with childhood type 1 diabetes.
RESULTS
The hazard ratio (HR) for childhood type 1 diabetes was increased in children delivered by prelabor cesarean section compared with vaginal delivery when adjusted for year of birth, parity, sex, parental age, and education and paternal type 1 diabetes status at childbirth (HR = 1.2; 95% confidence interval [CI] = 1.0, 1.3), but not after additional adjustment for maternal type 1 diabetes status at childbirth (HR = 1.1; 95% CI = 0.95, 1.2). Delivery by intrapartum cesarean section was not associated with childhood type 1 diabetes. Paternal type 1 diabetes was a stronger risk factor for childhood type 1 (HR = 12; 95% CI = 10, 14) than maternal type 1 diabetes (HR = 6.5; 95% CI = 5.2, 8.0).
CONCLUSIONS
Delivery by prelabor cesarean section was not associated with an increased risk of childhood type 1 diabetes in the offspring.
背景
剖宫产相关的不利因素可能会影响后代患1型糖尿病的风险，但研究结果相互矛盾。我们旨在评估临产前剖宫产与儿童期1型糖尿病风险之间的关联。
方法
一项丹麦全国队列研究追踪了1982年至2010年期间出生的所有单胎。四个国家登记处提供了分娩方式、结局和混杂因素的信息。通过Cox回归评估15岁前发病的儿童期1型糖尿病风险。共有1,760,336名单胎贡献了20,436,684人年，在此期间，4400人被诊断为儿童期1型糖尿病。
结果
在调整出生年份、产次、性别、父母年龄、教育程度和分娩时父亲的1型糖尿病状态后，与阴道分娩相比，临产前剖宫产出生的儿童患儿童期1型糖尿病的风险比（HR）升高（HR = 1.2；95%置信区间[CI] = 1.0, 1.3），但在进一步调整分娩时母亲的1型糖尿病状态后则不然（HR = 1.1；95% CI = 0.95, 1.2）。产时剖宫产与儿童期1型糖尿病无关。父亲患1型糖尿病比母亲患1型糖尿病是儿童期1型糖尿病更强的危险因素（HR = 12；95% CI = 10, 14），而母亲患1型糖尿病的HR为6.5（95% CI = 5.2, 8.0）。
结论
临产前剖宫产与后代患儿童期1型糖尿病的风险增加无关。
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