Do c-sections increase the risk of celiac disease?

NEW YORK (Reuters Health) - Children who develop celiac disease appear to be more likely to be born by cesarean section, German researchers say.

Celiac disease is a disorder in which eating gluten -- a type of protein found in wheat, barley, and rye -- causes the body’s immune system to attack and damage the small intestine. In the U.S., researchers think nearly 1 out of every 100 people has celiac disease.

Dr. Mathias Hornef, from Hannover Medical School in Germany, and his colleagues knew that people with certain inflammatory bowel diseases - such as celiac disease, Crohn’s disease, and ulcerative colitis - have a different mix of bacteria in their intestines.

How a child is delivered can affect that mix, so the researchers wondered if children with those diseases would have a higher rate of cesarean birth.

The team studied children and adolescents with Crohn’s disease, ulcerative colitis, or celiac disease. They also studied some children with other gastrointestinal problems, as well as a “control” group of children who were visiting local eye doctors and dentists for unrelated conditions.

The celiac children clearly had a higher rate of cesarean births compared to the other four groups. Twenty-eight percent of the celiac children were born by cesarean section, compared to no more than 19 percent of all the other groups. The celiac children were also diagnosed at a younger age, on average, than the other patients.

Hornef and colleagues are not sure why cesarean delivery might be associated with celiac disease but not Crohn’s disease or ulcerative colitis, because the three disorders develop in some similar ways. They say one explanation might be that celiac disease can be triggered much earlier in life, so the newborns with abnormal intestinal bacteria might be particularly vulnerable.

Hornef and his group note in their report that this is the first time anyone has found a link between cesarean delivery and children with celiac disease.

Researchers who were not involved in the study called the results intriguing, but said there may be explanations that don’t involve the way babies were born.

For example, Dr. Daniel Leffler, director of clinical research at the Celiac Disease Center at Boston’s Beth Israel Deaconess Medical Center, said many of the children’s mothers may have had undiagnosed celiac disease. Given that celiac disease can be inherited, and that undiagnosed celiac disease increases the risk of cesarean section, undiagnosed disease “would be more than enough to explain the increased number of cesareans,” he told Reuters Health.

“It may well be that celiac disease is showing up in the children, rather than in the mothers, because people are more alert to the possibility in kids,” he added.

Dr. Joseph Murray, a gastroenterologist who specializes in celiac disease at the Mayo Clinic in Rochester, Minnesota, said it would also be good to study whether there’s a similar link between cesarean birth and diabetes, which is closely related to celiac disease.

Hornef is quick to emphasize that cesarean sections can be lifesaving. Much larger studies, and far more data, would be needed “before we recommend something like trying to avoid c-section” as a way to avoid celiac disease, he told Reuters Health by e-mail.

If anything, the results “may mean we need to be looking for celiac disease in young women who want to become pregnant,” Leffler said. He noted that when celiac disease is treated with a gluten-free diet, the risk for cesarean section is no higher than for the average woman.

Untreated celiac disease, Leffler added, can have effects on the fetus as well, including slowing its growth and a higher risk of premature birth.

SOURCE: Pediatrics, online May 17, 2010.