{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T17:40:07Z","timestamp":1769017207097,"version":"3.49.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T00:00:00Z","timestamp":1717113600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T00:00:00Z","timestamp":1717113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U01 DK63829"],"award-info":[{"award-number":["U01 DK63829"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U01 DK63861"],"award-info":[{"award-number":["U01 DK63861"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U01 DK63821"],"award-info":[{"award-number":["U01 DK63821"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U01 DK63865"],"award-info":[{"award-number":["U01 DK63865"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Helmholtz Zentrum M\u00fcnchen - Deutsches Forschungszentrum f\u00fcr Gesundheit und Umwelt (GmbH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims\/hypothesis<\/jats:title>\n                <jats:p>Delivery by Caesarean section continues to rise globally and has been associated with the risk of developing type 1 diabetes and the rate of progression from pre-symptomatic stage 1 or 2 type 1 diabetes to symptomatic stage 3 disease. The aim of this study was to examine the association between Caesarean delivery and progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Caesarean section was examined in 8135 children from the TEDDY study who had an increased genetic risk for type 1 diabetes and were followed from birth for the development of islet autoantibodies and type 1 diabetes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The likelihood of delivery by Caesarean section was higher in children born to mothers with type 1 diabetes (adjusted OR 4.61, 95% CI 3.60, 5.90, <jats:italic>p<\/jats:italic>&lt;0.0001), in non-singleton births (adjusted OR 4.35, 95% CI 3.21, 5.88, <jats:italic>p<\/jats:italic>&lt;0.0001), in premature births (adjusted OR 1.91, 95% CI 1.53, 2.39, <jats:italic>p<\/jats:italic>&lt;0.0001), in children born in the USA (adjusted OR 2.71, 95% CI 2.43, 3.02, <jats:italic>p<\/jats:italic>&lt;0.0001) and in children born to older mothers (age group &gt;28\u201333 years: adjusted OR 1.19, 95% CI 1.04, 1.35, <jats:italic>p<\/jats:italic>=0.01; age group &gt;33 years: adjusted OR 1.80, 95% CI 1.58, 2.06, <jats:italic>p<\/jats:italic>&lt;0.0001). Caesarean section was not associated with an increased risk of developing pre-symptomatic early-stage type 1 diabetes (risk by age 10 years 5.7% [95% CI 4.6%, 6.7%] for Caesarean delivery vs 6.6% [95% CI 6.0%, 7.3%] for vaginal delivery, <jats:italic>p<\/jats:italic>=0.07). Delivery by Caesarean section was associated with a modestly increased rate of progression to stage 3 type 1 diabetes in children who had developed multiple islet autoantibody-positive pre-symptomatic early-stage type 1 diabetes (adjusted HR 1.36, 95% CI 1.03, 1.79, <jats:italic>p<\/jats:italic>=0.02). No interaction was observed between Caesarean section and non-HLA SNPs conferring susceptibility for type 1 diabetes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions\/interpretation<\/jats:title>\n                <jats:p>Caesarean section increased the rate of progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Data availability<\/jats:title>\n                <jats:p>Data from the TEDDY study (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.58020\/y3jk-x087\">https:\/\/doi.org\/10.58020\/y3jk-x087<\/jats:ext-link>) reported here will be made available for request at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research (R4R) (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/repository.niddk.nih.gov\/\">https:\/\/repository.niddk.nih.gov\/<\/jats:ext-link>).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00125-024-06176-7","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T05:01:36Z","timestamp":1717131696000},"page":"1582-1587","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Caesarean section and risk of type 1 diabetes"],"prefix":"10.1007","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0638-6882","authenticated-orcid":false,"given":"Tarini","family":"Singh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-0576","authenticated-orcid":false,"given":"Andreas","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6243-6772","authenticated-orcid":false,"given":"Kendra","family":"Vehik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-888X","authenticated-orcid":false,"given":"Jeffrey","family":"Krischer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-9207","authenticated-orcid":false,"given":"Marian","family":"Rewers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2228-334X","authenticated-orcid":false,"given":"Jorma","family":"Toppari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-0499","authenticated-orcid":false,"given":"\u00c5ke","family":"Lernmark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2979-0475","authenticated-orcid":false,"given":"William","family":"Hagopian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2351-5942","authenticated-orcid":false,"given":"Beena","family":"Akolkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8704-4713","authenticated-orcid":false,"given":"Ezio","family":"Bonifacio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6290-5548","authenticated-orcid":false,"given":"Anette-G.","family":"Ziegler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-3687","authenticated-orcid":false,"given":"Christiane","family":"Winkler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"TEDDY Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"issue":"3","key":"6176_CR1","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s00125-018-4763-3","volume":"62","author":"CC Patterson","year":"2019","unstructured":"Patterson CC, Harjutsalo V, Rosenbauer J et al (2019) Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989\u20132013: a multicentre prospective registration study. 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NIDDK central repository. https:\/\/doi.org\/10.58020\/y3jk-x087","DOI":"10.58020\/y3jk-x087"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-024-06176-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-024-06176-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-024-06176-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T22:47:38Z","timestamp":1724453258000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-024-06176-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,31]]},"references-count":11,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["6176"],"URL":"https:\/\/doi.org\/10.1007\/s00125-024-06176-7","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,31]]},"assertion":[{"value":"9 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Data from the TEDDY study ( []) reported here will be made available for request at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research (R4R) ().","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"The TEDDY study is funded by U01 DK63829, U01 DK63861, U01 DK63821, U01 DK63865, U01 DK63863, U01 DK63836, U01 DK63790, UC4 DK63829, UC4 DK63861, UC4 DK63821, UC4 DK63865, UC4 DK63863, UC4 DK63836, UC4 DK95300, UC4 DK100238, UC4 DK106955, UC4 DK112243, UC4 DK117483, U01 DK124166, U01 DK128847 and Contract No. HHSN267200700014C from the NIDDK, National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Environmental Health Sciences (NIEHS), Centers for Disease Control and Prevention (CDC) and JDRF. This work is supported in part by the National Institutes of Health (NIH)\/National Center for Advancing Translational Sciences (NCATS) Clinical and Translational Science Awards to the University of Florida (UL1 TR000064) and the University of Colorado (UL1 TR002535). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The work was supported by funds from the German Federal Ministry of Education and Research (FKZ 01KX1818) and by the Deutscher Diabetiker Bund e.V. (DDB). The funding sources were not involved in the design or conduct of the study; the collection, management, analysis or interpretation of the data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"TS, AW and CW performed the analyses. CW contributed substantially to data acquisition. A-GZ and EB supervised the statistical analyses. A-GZ, MR, JT, WH and AL are the principal investigators of the TEDDY study. TS, CW, AW, A-GZ and EB were involved in the interpretation of the results and preparation of the manuscript. KV, JK, MR, JT, AL, WH and BA were involved in interpretation of the data. All authors revised the manuscript critically for important intellectual content and approved the version to be published. CW takes responsibility for the integrity of the work as a whole.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}