Mode of delivery does not modify coeliac disease risk in infants
Mode of delivery does not modify coeliac disease (CD) risk among infants born into at-risk families, report Italian researchers at the 49th Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2016 in Athens, Greece.
To evaluate the relationship between the risk of CD and mode of delivery, this multicentre, prospective intervention trial compared early and delayed introduction of gluten to the diet of 832 infants born into at-risk families. [ESPGHAN 2016, abstract G-O-030]
The infants human leukocyte antigen (HLA) genotype was determined at 15 months, and serological screening for CD was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Intestinal biopsies were undertaken in infants with positive serological findings. The finial cohort comprised children found positive for HLA-DQ2 and/or HLA-DQ8 (n=533).
Two outcomes were measured: prevalence of CD autoimmunity or overt CD in children at 5 years based on mode of delivery, and nutritional and genetic variables (breastfeeding, age of gluten introduction, genotype, gender, intestinal infections, and CD affected first degree relative) on CD influence.
No difference in CD autoimmunity (24 and 19 percent; p=0.2) or overt CD (19 and 14 percent; p=0.2) was seen in children born through caesarean or vaginal delivery, at 5 years. Similarly, none of the nutritional or genetic variables were associated with CD development. However, children with high-risk HLA were more prone to CD autoimmunity (42 versus 19 percent; p<0.001) and overt CD (29 versus 15 percent; p<0.001) compared to children with standard-risk HLA.
Thus, HLA is the only known risk factor significantly associated with the development of CD autoimmunity and overt CD, concluded the researchers.
“Additional studies are needed to establish whether other environmental factors, such as the composition of microbiota, metabolic profile, vaccination schedule, and the use of antibiotics, affect the balance between gluten tolerance and immune response to gluten during the first years of life,” said study author Dr. Elena Lionetti from the University of Catania, Department of Pediatrics, Catania, Italy.