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IJE Advance Access published online on June 7, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn100
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Caesarean section among relatives

Mette C Tollånes1,2,3,*, Svein Rasmussen1,2,3,4 and Lorentz M Irgens1,2,3

1Department of Public Health and Primary Health Care, Section for Epidemiology and Medical Statistics, University of Bergen, Norway.
2Medical Birth Registry of Norway, Locus of Registry Based Epidemiology, University of Bergen, Norway.
3Norwegian Institute of Public Health, Oslo, Norway
4Department of Obstetrics and Gynaecology, Haukeland University Hospital, University of Bergen, Norway.

*Corresponding author. Department of Public Health and Primary Health Care, University of Bergen, Postboks 7804, N-5020 Bergen, Norway. E-mail: mette.tollanes{at}isf.uib.no.


  Abstract

Background Caesarean section rates are increasing. It is not clear whether a familial predisposition to caesarean section exists.

Methods Births registered in the Medical Birth Registry of Norway during 1967–2005 were linked to construct 440 236 grandmother–parent units and 275 001 same sex full sibling units. Log-binomial regression models were used to explore associations.

Results A mother born by caesarean section had a 55% increased risk of having her first child by caesarean section [adjusted relative risk (RR) 1.55, 95% CI 1.48–1.62]. The same was not found for fathers born by caesarean section (RR 1.02, 95% CI 0.96–1.10). A younger sister, whose older sister had her first child by caesarean section, had a 45% increased risk of having her first child by caesarean section (RR 1.45, 95% CI 1.40–1.51). If an older brother had his first child by caesarean, this did not constitute an increased risk for the younger brother's partner (RR 1.02, 95% CI 0.97–1.08). Similar associations were found in the subgroups of obstetric low risk deliveries.

Conclusions A female-to-female familial predisposition to caesarean section was observed. It could be caused by biologic inheritance, primarily working through maternal alleles and/or environmental factors. The results imply that both mechanisms could be important.

Keywords Familial predisposition, caesarean section, biologic inheritance, environmental factors

Accepted 7 May 2008


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