Saturday, 15 October 2011

The emergency exits are here and here

The title of this post has very little to do with steward / stewardess instructions delivered just before take-off, despite my recently watching the very funny Walliams/Lucas series 'Come Fly With Me'. Rather, with a straight face, I refer to your route into the world and whether Mother Nature required a helping hand in bringing you from the comfort of your watery cocoon into the real world. Could your route of entry alter your risk of developing certain things in later life... say coeliac (celiac) disease?

I am going to keep this post brief because this is a question that I have tackled before on a sister blog post: caesarean section and coeliac disease? The crux of that entry was the emerging suggestion that people born via caesarean section (c-section) were at greater risk of coeliac disease than those who were pushed through the bacteria-filled birth canal.

Further evidence has now emerged concerning a possible relationship in this paper by Marild and colleagues*. The details summarised:

  • A case-control study where recorded pregnancy information was collected via a central database between 1973 and 2008.
  • Biopsy-verified coeliac disease (CD) was determined for 11,749 participants compared with 53,887 age- and gender-matched non-CD general population controls.
  • There was a positive significant association between elective c-section delivery and later CD diagnosis (p=0.005) but none for emergency c-sections.
  • Small for dates babies were over 20% more likely to develop CD also.
  • No other pregnancy variables showed an association with CD.

I quote from the author's final sentence of their abstract: ".. consistent with the hypothesis that the bacterial flora of the newborn plays a role in the development of celiac disease".

I must point out that whilst bacterial colonisation of the infant gut may be a variable in determining your risk of CD, it is most probably not the only important variable. I don't want anyone reading this entry and taking it to their healthcare provider as 'proof' of anything; it is not. Likewise I am not trying to overturn any 'too posh to push' arguments.

What however can be inferred from this paper is that there may consequences to every action; some consequence might be positive (such as getting a breech presenting infant out of mum and avoiding any very serious complications), some of them might be not-so positive. The trick is to see where this research leads and, just a suggestion, whether an early bacterial 'transplant' from mum to baby one day becomes the norm for those babies who don't end up traversing the birth canal. Just a suggestion.

* Marild K. et al. Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study. Gastroenterology. October 2011.


  1. This is fascinating but I was slightly thrown by the researchers' use of the word 'later', at first (it could hardly be 'earlier'!).

    You omitted the finding that there was no association between coeliac and 'any' c-section - but I guess that could be down to some statistical quirk. I think it asks more questions that it answers that we're talking elective c-sections here. Why should elective over emergency make a difference?

    And I agree about the 'posh to push' stuff: I've written about this previously - many women go elective as they fear childbirth.


  2. Thanks for the comment Alex. Yes, I did omit the statistical non-association with any c-section to focus more on the 'elective' vs 'emergency' c-section finding. As to why one and not the other, I don't know enough about the difference to comment comprehensively but a clue might be in the small-for-dates finding, where planned c-sections (not for the too posh to push set) generally take place because baby is not following the right growth trajectory. The implication here is that smaller babies or babies showing slower in-utero might be at greater risk of CD?? Taken as a whole, the area of how we get into this world is seemingly becoming more and more important.

  3. Forgot to mention that I also found the idea of a bacterial transplant fascinating. This issue begs so many questions about the flora in the birth canal and how it transfers to babies - eg should we be 'cleaning' babies soon after birth, and could this hinder the colonisation process, or does it mainly occur during passage through the canal?

  4. Also agree with your suggestions. I note that here in the UK there is, in some hospitals, a general shift in post-birth practices. Babies are no longer just taken from mum and washed but instead 'skin-to-skin' contact is the first order and washing comes later - often when mum is discharged as a consequence of things like cutting down on the number of hospital-acquired infections, etc.
    Given that baby is in effect traversing a barrier from sterility to bacteria-filled exposures, there is plenty of scope that what bacteria the baby first comes into contact with might subsequently be related to what the immune system recognises as self and other onwards effects.

  5. Perhaps, with reference to elective vs emergency, in a lot of emergency cases the labour process has already begun and baby at least began its journey down the birth canal before the emergency c section. Where as in elective cases, generally the labour hormones have not kicked in, nor even movement down the birth canal.

  6. A very interesting possibility Vetty bearing in mind that emergency means emergency.

  7. I believe there was a study in Japan that showed a higher risk of autism in C-cections. Maybe for the same reasons as Celiac risk? Makes me wonder.

  8. Totally agree with your suggestion... Very nice post and good information here... Thanks for posting that....