Sezaryen ve Normal Vajinal Doğan Çocuklarda Tip 1 Diyabet Sıklığının Karşılaştırılması

Year 2020, , 114 - 118, 30.08.2020

İbrahim Ethem Şahin , Ceyhan Hacıoğlu , Merve Alpay , Önder Kiliçaslan

https://doi.org/10.18678/dtfd.731891

Cited By: 1

Abstract

Amaç: Tip 1 diyabetin dünya üzerindeki etkisi her geçen gün artmaktadır. Son yıllarda yaygınlaşan sezaryen doğum ve tip 1 diyabet riski arasında ilişkili olabilecek tartışmalı sonuçlar vardır. Bu çalışmada, doğum şekli ve tip 1 diyabet arasında bir bağlantı var olduğunu düşünerek sezaryen ve normal vajinal yolla doğan çocuklarda tip 1 diyabet görülme sıklığının araştırılması amaçlandı.

Gereç ve Yöntemler: Araştırmaya 2019 yılında diyabet polikliniğine başvuran 8-16 yaşları arasında olan tip 1 diyabet tanısı konmuş 368 çocuk dahil edildi. Hastalar doğum şekline göre gruplandırıldı. Hastalardan elde edilen yaş, cinsiyet, HBA1c ve BMI gibi tanımlayıcı veriler geriye dönük olarak değerlendirildi.

Bulgular: Tip 1 diyabet tanısı olan çocuklarda sezaryen doğumun normal vajinal doğuma göre %33,2 daha fazla olduğu görüldü (p<0,001). Sezaryen ile doğan çocukların %9,0’unun annesinde diyabet tanısı bulunurken, normal vajinal yolla doğan çocuklarda bu oran %5,7 idi. Benzer şekilde, sezaryen ile doğan çocukların %5,3’ünün babasında diyabet tanısı bulunurken, normal vajinal yolla doğan çocuklarda bu oran %8,9 idi.

Sonuç: Bu çalışmadan elde edilen sonuçlara göre, sezaryen doğum çocukluk veya ergenlik döneminde tip 1 diyabet riski üzerinde önemli bir etkiye sahip olabilir. Bununla birlikte, diyabetli ebeveyn olguları dahil edilmese bile, sezaryen ile doğum ve tip 1 diyabet arasında önemli bir ilişki olduğu bulunmuştur. Bununla ilgili olarak, daha ileri çalışmalara ihtiyaç duyulmaktadır.

Keywords

Sezaryen doğum, Normal vajinal doğum, Tip 1 diyabet

Comparison of Type I Diabetes Frequency in Children with Cesarean and Normal Vaginal Delivery

Abstract

Aim: The effect of type 1 diabetes mellitus over the world is rising day after day. There are controversial results that may be related to cesarean delivery that has become widespread in recent years and the risk of type 1 diabetes mellitus. In this study, we aimed to investigate the frequency of type 1 diabetes mellitus in children born by cesarean delivery or normal vaginal delivery, considering that there may be an association between mode of birth way and diabetes mellitus.

Material and Methods: The study was organized with 368 children who were diagnosed as type 1 diabetes mellitus between 8-16 ages that applied to the diabetes outpatient clinic in 2019. The patients were grouped according to the mode of delivery. Descriptive data such as age, gender, HBA1c, and BMI were evaluated retrospectively.

Results: The children with type 1 diabetes mellitus, cesarean delivery show 33.2% more than normal vaginal delivery (p<0.001). While 9.0% of children with cesarean delivery had mother's diabetes mellitus, this rate was 5.7% in children with normal vaginal delivery. Similarly, 5.3% of children with cesarean delivery had diabetes mellitus in their father, while this rate was 8.9% in children with normal vaginal delivery.

Conclusion: According to the results of this study, cesarean delivery may have a significant effect on the risk for type 1 diabetes mellitus in childhood either adolescence. Even if parents with diabetes were not included, it was found that cesarean delivery have meaningful relation by diabetes mellitus stimulation. Regarding this, further studies are needed.

Keywords

Caesarean delivery, Normal vaginal delivery, Type 1 diabetes

References

• American Diabetes Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20(7):1183-97.
• Sheetz MJ, King GL. Molecular understanding of hyperglycemia’s adverse effects for diabetic complications. JAMA. 2002;288(20):2579-88.
• Melendez-Ramirez LY, Richards RJ, Cefalu WT. Complications of type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39(3):625-40.
• International Diabetes Federation. IDF Diabetes Atlas. 6th ed. Basel, Switzerland: International Diabetes Federation; 2013.
• Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care. 2009;32(2):287-94.
• Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948-59.
• National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039-57.
• American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81-90.
• American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23(3):381-9.
• Stjernholm YV, Petersson K, Eneroth E. Changed indications for cesarean sections. Acta Obstet Gynecol Scand. 2010;89(1):49-53.
• Belizán JM, Althabe F, Cafferata ML. Health consequences of the increasing caesarean section rates. Epidemiology. 2007;18(4):485-6.
• Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML. Cesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2006;3:CD004660.
• Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32.
• Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and the risk for respiratory diseases in newborns. Obstet Gynecol. 2001;97(3):439-42.
• Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008;51(5):726-35.
• Brandão HV, Vieira GO, de Oliveira Vieira T, Camargos PA, de Souza Teles CA, Guimaraes AC, et al. Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort. BMC Pediatr. 2016;16:57.
• Mylonas I, Friese K. Indications for and risks of elective cesarean section. Dtsch Arztebl Int. 2015;112(29-30):489-95.
• Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.
• Stanton CK, Holtz SA. Levels and trends in cesarean birth in the developing world. Stud Fam Plann. 2006;37(1):41-8.
• Stene LC, Magnus P, Lie RT, Søvik O, Joner G, Norwegian Childhood Diabetes Study Group. No association between pre-eclampsia or caesarean section and incidence of type 1 diabetes among children: a large population-based cohort study. Pediatr Res. 2003;54(4):487-90.
• Taplin CE, Craig ME, Lloyd M, Taylor C, Crock P, Silink M, et al. The rising incidence of childhood type 1 diabetes in New South Wales, 1990-2002. Med J Aust. 2005;183(5):243-6.
• Samuelsson U, Lindell N, Bladh M, Åkesson K, Carlsson A, Josefsson A. Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study. Diabetologia. 2015;58(11):2517-24.
• Cardwell CR, Stene LC, Joner G, Davis EA, Cinek O, Rosenbauer J, et al. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia. 2010;53(4):641-51.
• Khashan AS, Kenny LC, Lundholm C, Kearney PM, Gong T, Mcnamee R, et al. Gestational age and birth weight and the risk of childhood type 1 diabetes: a population-based cohort and sibling design study. Diabetes Care. 2015;38(12):2308-15.
• Li S, Zhang M, Tian H, Liu Z, Yin X, Xi B. Preterm birth and risk of type 1 and type 2 diabetes: systematic review and meta-analysis. Obes Rev. 2014;15(10):804-11.
• Bingley PJ, Douek IF, Rogers CA, Gale EA. Influence of maternal age at delivery and birth order on risk of type 1 diabetes in childhood: prospective population based family study. Bart's-Oxford Family Study Group. BMJ. 2000;321(7258):420-4.
• van Belle TL, Coppieters KT, von Herrath MG. Type 1 diabetes: etiology, immunology, and therapeutic strategies. Physiol Rev. 2011(1);91:79-118.
• Herold KC, Vignali DAA, Cooke A, Bluestone JA. Type 1 diabetes: translating mechanistic observations into effective clinical outcomes. Nat Rev Immunol. 2013;13(4):243-56.
• Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69-82.
• Mire-Sluis AR, Gaines Das R, Lernmark A. The World Health Organization international collaborative study for islet cell antibodies. Diabetologia. 2000;43(10):1282-92.
• Bingley PJ, Bonifacio E, Mueller PW. Diabetes antibody standardization program: first assay proficiency evaluation. Diabetes. 2003;52(5):1128-36.
• Baekkeskov S, Aanstoot HJ, Christgau S, Reetz A, Solimena M, Cascalho M. Identification of the 64k autoantigen in insulin-dependent diabetes as the GABA-synthesizing enzyme glutamic acid decarboxylase. Nature. 1990;347(6289):151-6.
• Rhodes CJ, Alarcón C. What beta-cell defect could lead to hyperproinsulinemia in NIDDM? Some clues from recent advances made in understanding the proinsulin-processing mechanism. Diabetes. 1994;43(4):511-7.
• Wenzlau JM, Juhl K, Yu L, Moua O, Sarkar SA, Gottlieb P, et al. The cation efflux transporter ZnT8 (Slc30a8) is a major autoantigen in human type 1 diabetes. Proc Natl Acad Sci USA 2007;104(43):17040-5.
• Guarner F, Malagelada JR. Gut flora in health and disease. Lancet. 2003;361(9356):512-9.
• Salminen S, Gibson GR, McCartney AL, Isolauri E. Influence of mode of delivery on gut microbiota composition in seven year old children. Gut. 2004;53(9):1388-9.
• Grönlund MM, Lehtonen OP, Eerola E, Kero P. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr. 1999;28(1):19-25.
• Moreau MC, Ducluzeau R, Guy-Grand D, Muller MC. Increase in the population of duodenal immunoglobulin A plasmocytes in axenic mice associated with different living or dead bacterial strains of intestinal origin. Infect Immun. 1978;21(2):532-9.
• Shroff KE, Meslin K, Cebra JJ. Commensal enteric bacteria engender a self-limiting humoral mucosal immune response while permanently colonizing the gut. Infect Immun. 1995;63(19):3904-13.