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Mode of Delivery Does Not Affect the Risk of Inflammatory Bowel Disease

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Abstract

Background

Recent evidence suggests that exposures in early life that are known to influence microbiome development may affect the risk of developing inflammatory bowel disease (IBD). Cesarean section has been associated with altered colonization of commensal gut flora and is thought to predispose to immune-mediated diseases later in life.

Aims

To evaluate the risk of IBD, Crohn’s Disease (CD), and Ulcerative Colitis (UC) according to mode of delivery (C-section vs vaginal delivery).

Methods

A systematic search was performed in PubMed and Embase. The primary outcome was the risk of IBD in individuals delivered vaginally compared to those born by C-section. Secondary outcomes were UC and CD risk according to mode of delivery and IBD risk in individuals born by emergent compared to elective C-section. Publication bias was evaluated by funnel plots and Egger’s test. Study’s quality was characterized using the Newcastle–Ottawa Scale.

Results

Ten studies fulfilled the inclusion criteria, of which seven were population-based. No publication bias was detected. Overall, 14.164 IBD patients and 4.206.763 controls were included. Being born by C-section was not associated with increased risk of IBD [OR 1.01, 95% CI (0.81–1.27), p = 0.92], CD [OR 1.15, 95% CI (0.94–1.42), p = 0.18] or UC [OR 0.94, 95% CI (0.61–1.45), p = 0.79]. No differences were found between emergent and elective C-section in IBD [OR 1.05, 95% CI (0.59–1,87), p = 0.87]. Substantial heterogeneity was found in statistical analysis, and further studies are needed.

Conclusion

Overall, the risk of developing IBD was not affected by mode of delivery.

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Authors and Affiliations

  1. Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal

    Catarina Frias Gomes, Bárbara Morão, Marília Cravo & Joana Torres

  2. Gastroenterology Division, Medicine Department, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada

    Neeraj Narula

  3. Faculty of Medicine of Lisbon, University of Lisbon, Avenida Egas Moniz, Lisbon, Portugal

    Paulo Nicola

Authors
  1. Catarina Frias Gomes
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  2. Neeraj Narula
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  3. Bárbara Morão
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  4. Paulo Nicola
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  5. Marília Cravo
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  6. Joana Torres
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Contributions

All authors contributed to the manuscript’s concept and design. CG and BM independently extracted the data. Disagreements were solved through consensus or, if needed, by a third author (JT). NN performed the statistical analysis. CG wrote the manuscript. All authors critically revised the manuscript. All authors have approved the final version of the manuscript.

Corresponding author

Correspondence to Joana Torres.

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Frias Gomes, C., Narula, N., Morão, B. et al. Mode of Delivery Does Not Affect the Risk of Inflammatory Bowel Disease. Dig Dis Sci 66, 398–407 (2021). https://doi.org/10.1007/s10620-020-06204-7

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  • DOI: https://doi.org/10.1007/s10620-020-06204-7

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