This post will explore the connection between c-section and autoimmunity (AID) in the mother. It’s critical to make a few points clear before exploring the details of this possibility.

First, cesarean sections save the lives of babies and mothers. Period. This medical procedure deserves an incredible amount of respect for the people it helps.

Second, if you’re a mom that has received a c-section, you didn’t do anything wrong. You made the best choices for yourself and your baby and were given the best care possible to keep you safe!

Finally, this post is meant to raise awareness and prevent the possibility of autoimmunity—not to elicit fear. If you’ve had a c-section, I hope you feel empowered to properly support yourself and not feel afraid.

C-Section and Autoimmunity: What’s the Connection?

Unfortunately, this isn’t a subject that has been deeply investigated. In fact, while researching for this post, I found only a small handful of studies that helped me understand if a connection did, in fact, exist. And, was that connection one-directional or bi-directional? In other words…does a pre-existing autoimmune disease (even, perhaps, one that is not yet diagnosed) predispose a person to a c-section? Or, could receiving a c-section predispose a person to AID?

The most intriguing study examining this connection investigated groups of over one million Danish women. The women were categorized by age (<24 years old, 24 to 35 years old, and >35 years old). They were also classified according to:

• women who had never been pregnant
• women who had delivered their babies vaginally
• women who had a c-section
• women who had an abortion

The women were investigated for autoimmune diagnosis during, and for twelve years after, pregnancy—autoimmune thyroiditis, type 1 diabetes, ulcerative colitis, psoriasis vulgaris, rheumatoid arthritis, and polymyalgia rheumatica were the most common autoimmune diseases found.

The researchers found that approximately 2.4% of the women (25,570) were diagnosed with AID during pregnancy or the follow-up period. Interestingly, women who had been pregnant had a slightly increased chance of AID compared to women who had never been pregnant.

Women who delivered their baby via c-section had a significantly increased risk of autoimmunity during pregnancy, suggesting that perhaps a c-section delivery was more of an effect of current AID versus a cause of future AID.

And while disease risk was similar in the first year after delivery between women who delivered vaginally or had an abortion, there was a higher risk of AID in the younger and older groups of women who experienced c-sections in both the first and second year after giving birth (1). This finding can be interpreted in multiple ways—perhaps the mode of delivery does influence future AID risk.

However, it may be that an autoimmune disease is not yet at a diagnosable stage. In other words, it is present but still silent. To learn more about the stages of autoimmunity, read Dr. Heather Zwickey’s post “Three Stages of Autoimmune Disease.”

Does Autoimmunity Lead to C-Section?

If an autoimmune disease is present before delivery, the chances of c-section delivery may be increased. The reasons for this are still being explored but are linked to inflammatory dysregulation, AID-related difficulty with the physiological adaptations that occur during pregnancy, disease states, such as hypertension, the presence of autoantibodies, or side effects of prescription medication. Women with rheumatoid arthritis, Crohn’s disease, systemic lupus erythematosus, and type 1 diabetes, specifically, may have an increased risk for cesarean delivery. Multiple sclerosis may also carry this risk. However, studies exploring MS and c-section delivery provide mixed results (2).

But what about the reverse connection, the possibility that c-section delivery may somehow lead to an autoimmune diagnosis?

Does C-Section Lead to Autoimmunity?

According to the first study, it could. A hypothesis for the underlying cause of this connection is explained by the authors of the large Danish study described above (1). A phenomenon called fetal microchimerism, simply the presence of one person’s cells in another genetically distinct person, could be at play.

Interestingly, pregnancy is the most common cause of microchimerism. However, a debated connection between fetal microchimerism and the higher rates of AID in women has been described since 1998. The authors state that fetal/maternal hemorrhage, more likely to occur during a c-section, may increase the amount of microchimerism experienced by the mother. This higher amount of cell trafficking could lead to a greater risk of autoimmunity after cesarean section.

1. https://www.researchgate.net/publication/51163876_Pregnancy_and_the_Risk_of_Autoimmune_Disease
2. https://www.researchgate.net/publication/333411571_Obstetric_and_neonatal_complications_among_women_with_autoimmune_disease