Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies
Open accessAbstract
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.
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Cesarean birth is associated with adverse child health outcomes including asthma, type I diabetes, allergies, and obesity.
“established links between cesarean birth and adverse child health outcomes, including asthma, type I diabetes, allergies9–11 and obesity12”
From The relation between cesarean birth and child cognitive development (2017) · cites this paper as [9]
The estimated relations are established after controlling for socio-economic advantage associated with cesarean birth in Australia and a rich set of perinatal risk factors commonly used in child health studies.
“These relations are established after controlling for the socio-economic advantage associated with cesarean birth in Australia and a rich set of perinatal risk factors that (from meta-analyses)9, 11, 27 are commonly used in child health studies.”
From The relation between cesarean birth and child cognitive development (2017) · cites this paper as [9]
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- Authors
- Cardwell, C. R., Stene, L. C., Joner, G., Cinek, O., Svensson, J., Goldacre, M. J., Parslow, R. C., Pozzilli, P., Brigis, G., Stoyanov, D., Urbonaitė, B., Šipetić, S., Schober, E., Ionescu-Tirgoviste, C., Devoti, G., de Beaufort, C. E., Buschard, K., & Patterson, C. C.
- Affiliations
- Queen's University Belfast (GB)
- Norwegian Institute of Public Health (NO)
- University of Oslo (NO)
- Charles University (CZ)
- University of Oxford (GB)
- University of Leeds (GB)
- Università Campus Bio-Medico (IT)
- Lithuanian University of Health Sciences (LT)
- Medical University of Vienna (AT)
- University of Salento (IT)
- Rigshospitalet (DK)
- Corresponding author
- Cardwell, C. R.
- ORCID
- Venue
- Diabetologia
- Published
- 2008-02-22
- Volume
- 51
- Issue
- 5
- Pages
- 726-735
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2165387067
- Cited by
- 590
- References
- 50
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 35 · 2023: 39 · 2022: 25 · 2021: 41 · 2020: 45 · 2019: 40 · 2018: 45 · 2017: 51 · 2016: 45 · 2015: 34 · 2014: 44 · 2013: 29 · 2012: 28
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Open Repository and Bibliography (University of Luxembourg) (submittedVersion, other-oa)
- AIRUS (submittedVersion)
- Lithuanian University of Health Sciences (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Funders
- Diabetes UK
- Norges Forskningsråd
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Keywords
- cesarean section, childhood-onset type 1 diabetes, type 1 diabetes risk, birth weight, gestational age, maternal age, birth order, breastfeeding, maternal diabetes, confounding adjustment
- MeSH terms
- Adult, Birth Order, Birth Weight, Cesarean Section, Child, Diabetes Mellitus, Type 1, Female, Humans, Infant, Newborn, Maternal Age, Pregnancy, Risk Factors, Age of Onset
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