Risk of Type 1 Diabetes in children and adolescents born through elective and emergency Cesarean section: a meta-analysis

TY - JOUR

T1 - Risk of Type 1 Diabetes in children and adolescents born through elective and emergency Cesarean section: a meta-analysis

AU - Tanoey, Justine

AU - Gulati, Amit

AU - Becher, Heiko

PY - 2017

Y1 - 2017

N2 - Cesarean section (CS) has been suggested to increase the risk of Type 1 Diabetes (T1DM) in the offspring. However, most studies do not highlight the difference between elective and emergency CS. This meta-analysis aims to elucidate T1DM risk in children and adolescents after elective or emergency CS compared to vaginal birth.A systematic literature search was done in MEDLINE, Web of Science, and CINAHL. Studies are included when effect sizes (or sufficient data) of elective and emergency CS and vaginal delivery on T1DM risk in children or adolescents are reported. Effect sizes was estimated in fixed and random effects model. Heterogeneity was investigated by DerSimonian and Laird method, and publication bias with funnel plots. Sensitivity analysis was done by type of study. All statistical analysis was performed using R. Evidence quality was assessed following the GRADE guidelines.Literature search yielded 8 (5 cohort and 3 case-control) eligible studies for meta-analysis. Summary crude effect estimates showed no significant T1DM risk posed by CS {OR 1.04 (0.96 – 1.13)}, nor by elective CS {OR 1.07 (0.98 – 1.18)} or emergency CS {1.05 (0.89 – 1.25)}. Overall adjusted OR did not show significant T1DM risk associated with elective CS {OR 1.08 (0.96 – 1.20)} nor emergency CS {OR 1.04 (0.94 – 1.15)}. There was moderate to high heterogeneity among studies, and funnel plots indicated some publication bias. Sensitivity analysis of adjusted effect estimates showed a slightly increased T1DM risk associated with elective CS in cohort studies {OR 1.13 (1.06 – 1.20)}, and a higher risk associated with emergency CS in a case-control study {OR 1.20 (1.08 – 1.32)}. The evidence is of low quality according to GRADE.Available evidence suggest that both methods of CS may be associated with a slight increase of T1DM risk in the offspring. However, the number of high quality studies on this field is low and more studies are required for more definite and higher quality results.

AB - Cesarean section (CS) has been suggested to increase the risk of Type 1 Diabetes (T1DM) in the offspring. However, most studies do not highlight the difference between elective and emergency CS. This meta-analysis aims to elucidate T1DM risk in children and adolescents after elective or emergency CS compared to vaginal birth.A systematic literature search was done in MEDLINE, Web of Science, and CINAHL. Studies are included when effect sizes (or sufficient data) of elective and emergency CS and vaginal delivery on T1DM risk in children or adolescents are reported. Effect sizes was estimated in fixed and random effects model. Heterogeneity was investigated by DerSimonian and Laird method, and publication bias with funnel plots. Sensitivity analysis was done by type of study. All statistical analysis was performed using R. Evidence quality was assessed following the GRADE guidelines.Literature search yielded 8 (5 cohort and 3 case-control) eligible studies for meta-analysis. Summary crude effect estimates showed no significant T1DM risk posed by CS {OR 1.04 (0.96 – 1.13)}, nor by elective CS {OR 1.07 (0.98 – 1.18)} or emergency CS {1.05 (0.89 – 1.25)}. Overall adjusted OR did not show significant T1DM risk associated with elective CS {OR 1.08 (0.96 – 1.20)} nor emergency CS {OR 1.04 (0.94 – 1.15)}. There was moderate to high heterogeneity among studies, and funnel plots indicated some publication bias. Sensitivity analysis of adjusted effect estimates showed a slightly increased T1DM risk associated with elective CS in cohort studies {OR 1.13 (1.06 – 1.20)}, and a higher risk associated with emergency CS in a case-control study {OR 1.20 (1.08 – 1.32)}. The evidence is of low quality according to GRADE.Available evidence suggest that both methods of CS may be associated with a slight increase of T1DM risk in the offspring. However, the number of high quality studies on this field is low and more studies are required for more definite and higher quality results.

U2 - 10.1055/s-0037-1605923

DO - 10.1055/s-0037-1605923

M3 - Konferenz-Abstract in Fachzeitschrift

VL - 79

SP - 656

EP - 804

JO - GESUNDHEITSWESEN

JF - GESUNDHEITSWESEN

SN - 0941-3790

IS - 08/09

ER -