title: History of cesarean section associated with childhood onset of T1DM in Newfoundland and Labrador, Canada.
abstract: OBJECTIVE
  Newfoundland and Labrador (NL) has one of the highest incidences of Type 1 diabetes mellitus (T1DM) worldwide. Rates of T1DM are increasing and the search for environmental factors that may be contributing to this increase is continuing.
  
  
  METHODS
  This was a population-based case control design involving the linkage of data from a diabetes database with live birth registration data. 266 children aged 0-15 years with T1DM were compared to age- and gender-matched controls. Chi-square analysis and multivariate conditional logistic regression were carried out to assess maternal and infant factors (including maternal age, marital status, education, T1DM, hypertension, birth order, delivery method, gestational age, size-for-gestational-age, and birth weight).
  
  
  RESULTS
  Cases of T1DM were more likely to be large-for-gestational-age (P = 0.024) and delivered by C-section (P = 0.009) as compared to controls. C-section delivery was associated with increased risk of T1DM (HR 1.41, P = 0.015) when birth weight and gestational age were included in the model, but not when size-for-gestational-age was included (HR 1.3, P = 0.076).
  
  
  CONCLUSIONS
  Birth by C-section was found to be a risk factor for the development of T1DM in a region with high rates of T1DM and birth by C-section. These findings may have an impact on health practice, health care planning, and future research.
authors: Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada.
authors: J
authors: J
authors: Phillips
authors: N
authors: N
authors: Gill
authors: K
authors: K
authors: Sikdar
authors: S
authors: S
authors: Penney
authors: L A
authors: LA
authors: Newhook
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009523:Newfoundland and Labrador / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors