Abstract
BackgroundCeliac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood.MethodsUsing Sweden’s national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period.ResultsRegardless of sex, a reduction in CD risk was observed in children born to mothers aged ≥35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7–0.9) and with high maternal income (OR 0.9; 95 % CI 0.8–0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0–1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2–0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0–1.2).ConclusionsElective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.
Highlights
Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures
Bivariate and multivariate results for all children In the bivariate analysis, increased childhood CD risk was significantly associated with maternal age 25–29 years, middle income, being a second born child, maternal infections in general during pregnancy, and being a female (Table 3)
Reduced CD risk was independently associated with maternal age ≥35 years, high maternal income, maternal overweight, parity ≥3, preterm delivery, Premature rupture of the membrane (PROM), very low birth weight, and low Apgar score at 5 min after delivery
Summary
Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. The immune system develops through interaction with the environmental factors and it is assumed that early life events, including fetal life, play a major role in this process. Changes in the infant’s microbiota have been shown to occur following birth, infections, antibiotic use and diet (in particular breastfeeding), influencing the immune system [12,13,14]. Given this background, factors related to maternal health and other early life events that impact these processes are of interest to study in relation to CD risk. We use a large database consisting of the entire Swedish child population and subsequent childhood CD cases identified nationwide with the aim of investigating how conditions related to maternity, delivery and the neonatal period influence the risk of getting a CD diagnosis during childhood
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