History of Cesarean Section Associated with Childhood Onset of T1DM in Newfoundland and Labrador, Canada

Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada.
Journal of Environmental and Public Health 07/2012; 2012(2, article e35):635097. DOI: 10.1155/2012/635097
Source: PubMed


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.
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).
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).
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.

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    • ", maternal age at delivery, maternal marital status, maternal education, family income, maternal prescription of diabetes medications during the follow-up period and foetal growth Phillips et al. 2012 (23) "
    S. Li · M. Zhang · H. Tian · Z. Liu · X. Yin · B. Xi ·
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    ABSTRACT: Preterm birth is suggested to play an important role in the development of diabetes. However, results have been inconsistent. We conducted a systematic review and meta-analysis to clarify the relationship between preterm birth and type 1 and type 2 diabetes. PubMed, Embase and ISI Web of Science were searched. A total of 18 studies (including 2,176,480 participants and 22,073 cases) for type 1 diabetes and five studies (including 31,478 participants and 1,898 cases) for type 2 diabetes were included in the current meta-analyses. We calculated pooled odds ratio (OR) and 95% confidence interval (CI) using fixed-effects model to evaluate the relations between preterm birth and type 1 and type 2 diabetes. The results suggested that preterm birth was significantly associated with increased risk of type 1 diabetes (OR = 1.18, 95% CI = 1.11–1.25), with no evidence of between-study heterogeneity (I2 = 13.2%, P = 0.296). Preterm birth was also significantly associated with increased risk of type 2 diabetes (OR = 1.51, 95% CI = 1.32–1.72), with no evidence of (I2 = 0.0%, P = 0.557). Subgroup analyses suggested that there was significant association in both case-control studies (OR = 1.16, 95% CI = 1.06–1.26) and cohort studies (relative risk = 1.20, 95% CI = 1.11–1.29) for type 1 diabetes, and similar results were found for type 2 diabetes. The results suggested that preterm birth was a significant and independent risk factor for both type 1 and type 2 diabetes.
    Obesity Reviews 08/2014; 15(10). DOI:10.1111/obr.12214 · 8.00 Impact Factor
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    • "The rates of C-section have increased in NL to 33% in 2010 [27]. Recent results from a population-based case–control study showed that birth by cesarean section is associated with T1DM in NL(HR 1.41, p=0.015) [28]. A recent meta-analysis of 20 studies found that the combined effect of C-section delivery on T1DM risk was 1.23 (95% CI 1.15-1.32) "
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    ABSTRACT: Background To study and update the provincial incidence of type 1 diabetes mellitus (T1DM) in Newfoundland and Labrador (NL), a province of Canada with a very high incidence previously reported in 2006, and one of the highest incidences reported worldwide. This is a retrospective time trend study of the incidence of T1DM, in children aged 0–14 years from 1987–2010 inclusive. Findings Over the study period 931 children aged 0–14 years were diagnosed with T1DM. The incidence of T1DM in this population over the period 1987 – 2010 inclusive was 37.7 per 100,000 per year (95% CI 35. 3, 40.2) The incidence from 2007–2010 was 49.9 per 100,000 per year (95% CI 42.2, 57.6). The incidence over this 24 year period increased by a factor of 1.03 per 100,000 per year. Conclusion NL has one of the highest incidences of T1DM reported worldwide. Potential reasons for the very high incidence could be related to the unique genetic background of the population, northern latitude and vitamin D insufficiency, low breastfeeding rates, and high rates of cesarean section.
    BMC Research Notes 11/2012; 5(1):628. DOI:10.1186/1756-0500-5-628
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