title: Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study.
abstract: OBJECTIVE
  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 examined the risk of celiac disease in individuals exposed to cesarean delivery and adverse fetal events (ie, 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 [OR], 1.15; 95% confidence interval [CI], 1.04-1.26), but no increased risk of celiac disease after emergency (adjusted OR, 1.02; 95% CI, 0.92-1.13) or any cesarean delivery (adjusted OR, 1.06; 95% CI, 0.99-1.13). Infants born small for gestational age were at a 21% increased risk of celiac disease (95% CI, 1.09-1.35), 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.
authors: Astrid Lindgren Children's Hospital, Solna, Sweden. karlmarild@gmail.com
authors: Karl
authors: K
authors: Mårild
authors: Olof
authors: O
authors: Stephansson
authors: Scott
authors: S
authors: Montgomery
authors: Joseph A
authors: JA
authors: Murray
authors: Jonas F
authors: JF
authors: Ludvigsson
mesh_terms: D000328:Adult; D001034:Apgar Score; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D002585:Cesarean Section / Q000009:adverse effects; D003141:Communicable Diseases / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult