Pregnancy Outcome and Risk of Celiac Disease in Offspring: A Nationwide Case-Control Study

Abstract

Background & Aims Studies on pregnancy characteristics and mode of delivery and risk of later celiac disease in offspring are inconsistent. In recent decades rates of cesarean delivery and preterm birth survival have increased while at the same time the prevalence of celiac disease has doubled. Methods In this population-based case-control study we examine the risk of celiac disease in individuals exposed to cesarean delivery and adverse fetal events (i.e. low Apgar score, small for gestational age, low birth weight, preterm birth, and neonatal infections). Prospectively recorded pregnancy data were obtained from the Swedish Medical Birth Register between 1973 and 2008. Study participants consisted of 11,749 offspring with biopsy-verified celiac disease identified through histopathology reports from Sweden’s 28 pathology departments and 53,887 age- and sex-matched controls from the general population. Results We found a positive association between elective cesarean delivery and later celiac disease (adjusted odds ratio (AOR) = 1.15; 1.04-1.26; p = 0.005), but no increased risk of celiac disease following emergency (AOR = 1.02; 0.92-1.13; p = 0.749) or any cesarean delivery (AOR = 1.06; 0.99-1.13; p = 0.074). Infants born small for gestational age were at a 21% increased risk of celiac disease (95% CI = 1.09-1.35; p = 0.001), whereas other pregnancy exposures did not increase the risk of future celiac disease. Conclusions The positive association with elective, but not emergency, cesarean delivery is consistent with the hypothesis that the bacterial flora of the newborn plays a role in the development of celiac disease.