Caesarian section and MS

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Epub ahead of printMaghzi et al. Cesarean delivery may increase the risk of multiple sclerosis. Mult Scler. 2011 Oct 7.

Background: Pregnancy related factors are believed to contribute to the risk of developing MS.


Objective: This study was designed to evaluate whether mode of delivery (vaginal versus cesarean section), as a perinatal factor, affects susceptibility to MS. 

Methods: MS’ers were recruited from the MS registry of Isfahan MS Society and were compared with their healthy siblings. Data regarding mode of delivery, birth order, and gestation week of birth were obtained through a specially designed questionnaire. Preterm or post term deliveries were excluded. 


Results: This study included 1349 participants (449 MS’ers and 900 controls). Subjects who were born by cesarean section had significant risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI: 1.43-4.41; p = 0.001). There was significant MS risk for females who were born by cesarean section (OR = 2.69, 95% CI: 1.30-5.58; p = 0.008), but not for males (OR = 2.25, 95% CI: 0.90-5.63; p = 0.082). The average age at onset was lower in MS’ers born by cesarean section (24.58 ± 6.33) compared to those born by vaginal delivery (27.59 ± 7.97; p = 0.041). There was no significant difference between the two groups for birth order. 

Conclusion: These results suggest that those born by vaginal delivery are at a lower risk of subsequent MS. These preliminary findings will need to be addressed in a much larger and preferably prospective study.

“An interesting observation that will need to confirmed. The best place to do this would be in Denmark or Sweden using their national databases.”

“Now the million dollar question; how does caesarian section relate to MS risk? I suspect this may be an association. Could the factor or factors that predispose to MS risk in pregnancy also predispose to caesarian section? Any ideas?”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

9 comments

  • You know, this type of coverage isn't helpful. The more ideas that are bandied about MS causation, the more ludicrous the situation becomes.

    The notion that caesarean deliver contributes to the development of MS in offspring needs for more exposition. You need to at least substantiate why you may think it has a contributory effect.

    I so wish we at least had a tangible idea why MS happens even if we can't cure it. By not having a solid framework of potential causes, any statistician can draw up bemusing claims. Why not just say MS is a result of sitting under trees, or using too much underarm deodorant. You could probably present a solid statistical case for it.

  • Prof G, I don't understand why you have posted this. This sounds like completely garbage research. Why should it only affect women? For someone who seems to know about the Bradford Hill criteria surely you know this is bad science. If it is replicated I will eat my hat.

  • This might be a potential angle. There has been some research on gut bacteria and MS (http://www.sciencedaily.com/releases/2010/07/100719162643.htm, http://jcm.asm.org/cgi/content/full/44/6/2099) and more on the relationship between gut bacteria and the brain or immune system.

    This article (http://www.nature.com/nature/journal/v476/n7361/full/476393a.html, which you may not be able to see) is mostly about the effects of antibiotics, but it also notes

    "Babies acquire their founding bacterial populations from their mothers while passing through the vagina at birth. So each generation — particularly the 30% or so of infants born via Caesarian — could be beginning life with a smaller endowment of ancient microbes than the last."

    I don't know what would explain the fact that the difference was only found in women.

  • Re: "This sounds like completely garbage research. Why should it only affect women? For someone who seems to know about the Bradford Hill criteria surely you know this is bad science. If it is replicated I will eat my hat."

    It is definitely not garbage; it is simply an observation. The finding probably applies to men as well (there is a trend in the data; but the study is underpowered for men). These types of studies need to be confirmed and if it is confirmed we need to explain the biology. People born by caesarean sections are different to people born by the normal vaginal route. Reasons for doing a caesarean section are multiple, but one of them is foetal distress. Foetal distress results in a large amount of steroids being produced, from the adrenal glands. The steroids could for example affect the development of the immune system and predispose people to autoimmune diseases in later life. There is a large body of evidence showing that maternal and foetal stress in rodents affects immune function later in life. So I don't think it is garbage; we simply need to consider it another piece of the giant MS jigsaw puzzle that will need to be explained when we identify and confirm the cause of MS.

  • really interesting…

    About five years ago there a large
    published in Canada about c-section
    babies and the statistical significant finding of increased
    asthma. The researchers thoughts,
    certain hormones (protective?)that are
    normally released in the fetus
    lung tissue in normal birth process
    are not being produced in
    c-sections.

    A little off topic but I also read
    last year about Autistic children
    and siblings having very genetically different bacteria in
    their guts health controls, even
    normal siblings bacteria were
    50pc abnormal if they had a brother
    or sister with autism – UK researh.

  • Iam female with ms born by caesarian section with low vitamin d levels who gave birth to a daughter who was also born by caesarian section and who also has been found to have severe low levels of vitamin d !

  • My daughter was born through C Section, was formula fed, got her first antibiotic before she even tasted any milk, antibiotics always preceded her attacks. She was 13 when diagnosed with MS. No doctor ever tested her vitamin D level until the diagnosis. No doctor ever tested any of her other vitamins/minerals even though she was showing symptoms of vitamin deficiencies. I just recently pulled her records out and found out they were only testing calcium and liver and kidney functions. In children????

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