Caesarean Delivery and Risk of Chronic Inflammatory Diseases (Inflammatory BowelDisease, Rheumatoid Arthritis, Coeliac Disease, and Diabetes Mellitus): A Population Based Registry Study of 2,699,479 Births in Denmark During 1973-2016

Andersen V1,2,3, Möller S4, Jensen PB4, Møller FT5,6, Green A4. Clin Epidemiol. 2020 Mar 9;12:287-293. doi: 10.2147/CLEP.S229056. eCollection 2020.


Author information

1 Focused Research Unit for Molecular Diagnostic and Clinical Research (MOK), Hospital of Southern Jutland, Åbenrå DK-6200, Denmark.

2 Institute of Regional Research (IRS-Center Sonderjylland), University of Southern Denmark, Odense C DK-5000, Denmark.

3 Institute of Molecular Medicine, University of Southern Denmark, Odense C DK-5000, Denmark.

4 Open Patient data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense C DK-5000, Denmark.

5 Department of Epidemiology Research, Statens Serum Institute, Copenhagen DK-2300, Denmark.

6 Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institute, Copenhagen DK-2300, Denmark.


BACKGROUND: Chronic inflammatory diseases in childhood and early adult life share aetiological factors operating from birth and onwards. In this study, we use data from the national Danish health registers to evaluate the risk of developing four common, immune-mediated hospital-diagnosed childhood chronic inflammatory diseases.

METHODS: A national population-based registry study. Data from the Danish Medical Birth Registry and the Danish National Patient Registry from January 1973 to March 2016 were linked at a personal level to evaluate any potential associations between caesarean section and development of Inflammatory bowel diseases, rheumatoid arthritis, coeliac disease and diabetes mellitus among the offspring. A model adjusted for parental age at birth, decade of birth, gender of child, and parents' chronic inflammatory disease status was used.

RESULTS: This register-based national cohort study of 2672708 children with information on delivery mode found an increased risk of diabetes, arthritis, coeliac disease, and inflammatory bowel disease for both girls and boys after caesarean section compared with vaginal delivery. The higher risk was present at least 40 years after delivery. In a subgroup analysis, both acute and elective caesarean section was associated with an increased risk of developing a chronic inflammatory disease.

CONCLUSIONS: Being born by caesarean section leads to increased host susceptibility for chronic inflammatorydiseases that last for decades. This finding should be further addressed in future studies with the aim to support the development of new strategies for prevention, treatment, and maybe even cure.

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