Preterm Birth and the Risk for Childhood Celiac Disease of the Offspring

Abstract Purpose: Preterm infants may be predisposed to immune-mediated disorders due to an immature immune system and an altered gut microbiome. We investigated whether offspring born preterm (<37 weeks) are at an increased independent risk of developing childhood celiac disease compared to term offspring. Methods : A population-based cohort study (1991-2021) included all singleton deliveries at a single tertiary medical center. Celiac disease diagnoses up to 18 years of age were retrieved from hospital and community records. A multivariable Cox proportional-hazards model was utilized to compare the study groups, adjusting for maternal age, maternal celiac disease, and small for gestational age (SGA) . Results: Of 356,109 included singleton deliveries, 24,511 (6.9%) were preterm. Crude celiac disease prevalence was higher in preterm versus term offspring (0.7% vs. 0.5%, p=0.012), with a non-significant trend toward higher cumulative incidence (Log-rank, p=0.087). In the multivariable Cox model, after adjusting for maternal age, maternal celiac disease, and SGA, prematurity was not independently associated with celiac disease in the offspring (adjusted hazard ratio 1.14, 95%CI 0.97-1.34, p =0.103). Conclusion : While PTB is associated with a higher crude rate of disease, it is not an independent risk factor once adjusted for maternal characteristics and SGA.