剖宫产术与 1 型糖尿病风险。

Caesarean section and risk of type 1 diabetes.

机构信息

Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.

Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.

出版信息

Diabetologia. 2024 Aug;67(8):1582-1587. doi: 10.1007/s00125-024-06176-7. Epub 2024 May 31.

DOI:10.1007/s00125-024-06176-7

PMID:38819466

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11343945/

Abstract

AIMS/HYPOTHESIS: Delivery by Caesarean section continues to rise globally and has been associated with the risk of developing type 1 diabetes and the rate of progression from pre-symptomatic stage 1 or 2 type 1 diabetes to symptomatic stage 3 disease. The aim of this study was to examine the association between Caesarean delivery and progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.

METHODS

Caesarean section was examined in 8135 children from the TEDDY study who had an increased genetic risk for type 1 diabetes and were followed from birth for the development of islet autoantibodies and type 1 diabetes.

RESULTS

The likelihood of delivery by Caesarean section was higher in children born to mothers with type 1 diabetes (adjusted OR 4.61, 95% CI 3.60, 5.90, p<0.0001), in non-singleton births (adjusted OR 4.35, 95% CI 3.21, 5.88, p<0.0001), in premature births (adjusted OR 1.91, 95% CI 1.53, 2.39, p<0.0001), in children born in the USA (adjusted OR 2.71, 95% CI 2.43, 3.02, p<0.0001) and in children born to older mothers (age group >28-33 years: adjusted OR 1.19, 95% CI 1.04, 1.35, p=0.01; age group >33 years: adjusted OR 1.80, 95% CI 1.58, 2.06, p<0.0001). Caesarean section was not associated with an increased risk of developing pre-symptomatic early-stage type 1 diabetes (risk by age 10 years 5.7% [95% CI 4.6%, 6.7%] for Caesarean delivery vs 6.6% [95% CI 6.0%, 7.3%] for vaginal delivery, p=0.07). Delivery by Caesarean section was associated with a modestly increased rate of progression to stage 3 type 1 diabetes in children who had developed multiple islet autoantibody-positive pre-symptomatic early-stage type 1 diabetes (adjusted HR 1.36, 95% CI 1.03, 1.79, p=0.02). No interaction was observed between Caesarean section and non-HLA SNPs conferring susceptibility for type 1 diabetes.

CONCLUSIONS/INTERPRETATION: Caesarean section increased the rate of progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.

DATA AVAILABILITY

Data from the TEDDY study ( https://doi.org/10.58020/y3jk-x087 ) reported here will be made available for request at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research (R4R) ( https://repository.niddk.nih.gov/ ).

摘要

目的/假设：剖宫产术在全球范围内持续增加，并与 1 型糖尿病的发病风险以及从无症状的 1 型糖尿病早期阶段 1 或 2 期进展为有症状的 3 期疾病的速度有关。本研究的目的是检查剖宫产术与无症状早期 1 型糖尿病儿童进展为 3 期 1 型糖尿病之间的关系。

方法

在 TEDDY 研究中，对 8135 名具有 1 型糖尿病遗传高风险的儿童进行了剖宫产术检查，这些儿童从出生起就接受胰岛自身抗体和 1 型糖尿病的监测。

结果

剖宫产术的发生几率在以下儿童中更高：患有 1 型糖尿病的母亲所生的儿童（校正 OR 4.61，95%CI 3.60，5.90，p<0.0001）、非单胎出生的儿童（校正 OR 4.35，95%CI 3.21，5.88，p<0.0001）、早产的儿童（校正 OR 1.91，95%CI 1.53，2.39，p<0.0001）、出生于美国的儿童（校正 OR 2.71，95%CI 2.43，3.02，p<0.0001）和高龄母亲所生的儿童（年龄组>28-33 岁：校正 OR 1.19，95%CI 1.04，1.35，p=0.01；年龄组>33 岁：校正 OR 1.80，95%CI 1.58，2.06，p<0.0001）。剖宫产术与无症状早期 1 型糖尿病的发病风险增加无关（10 岁时的风险为 5.7%[95%CI 4.6%，6.7%]，经阴道分娩为 6.6%[95%CI 6.0%，7.3%]，p=0.07）。对于已经发展为多种胰岛自身抗体阳性无症状早期 1 型糖尿病的儿童，剖宫产术与进展为 3 期 1 型糖尿病的发生率略有增加（校正 HR 1.36，95%CI 1.03，1.79，p=0.02）。未观察到剖宫产术与非 HLA 单核苷酸多态性（SNP）之间存在交互作用，这些 SNP 与 1 型糖尿病的易感性有关。

结论/解释：剖宫产术增加了无症状早期 1 型糖尿病儿童进展为 3 期 1 型糖尿病的风险。