Perinatal Risk Factors for Inflammatory Bowel Disease: A Case-Control Study

Abstract

To examine perinatal risk factors for Crohn's disease and ulcerative colitis, the authors analyzed birth records for 257 known case participants delivered from 1924 through 1957 at the University Hospital in Uppsala County, Sweden, and compared them with records for 514 controls delivered at the hospital. The two groups were matched by date of birth, sex, and either maternal age or parity. Eleven study variables were abstracted from standard forms that recorded health events during the pregnancy and the delivery hospitalization. Participants were more likely than controls to have a recorded health event (odds ratio (OR) = 4.4; 95% confidence interval (CI) 3.0-6.4). In a multivariate model, this increased risk was evident for infectious (OR = 3.8; 95% CI 2.6-5.8) and noninfectious (OR = 3.5; 95% CI 2.0-6.3) events. Perinatal health events may have contributed to 40% of the inflammatory bowel disease cases in our study. Infants from families with low socioeconomic status had greater risk of inflammatory bowel disease than did infants from families with high socioeconomic status (OR = 3.0, 95% CI 1.5-6.1). Perinatal health events and low socioeconomic status independently increased the risk of inflammatory bowel disease.

Impact of Clostridium difficile colitis on 5‐year health outcomes in patients with ulcerative colitis

“…Colonised C. difficile spores and vegetative organisms in some patients could theoretically give rise to abnormal and/ or exaggerated immune responses, as has been hypothesised for other host and pathogenic microbes in IBD. [20][21][22][23][24][25][26] In addition, the physiologic stress associated with CDC may exacerbate other illnesses, such as cardiovascular disease and renal insufficiency, which could further influence long-term prognosis in these patients. Clostridium difficile colitis may also give rise to a more aggressive form of acute colitis, which may partly explain the higher in-hospital mortality risk observed in these patients.…”

Pathogenesis of Crohn’s disease: Bug or no bug

“…An example that supports infections as a risk factor is found in Ekbom's case-control study, carried out in 1990 to determine the potential role of infections during infancy in the pathogenesis of IBD [73] . Analysis of perinatal events and risk of CD found postnatal infections to be the factor that was associated most strongly, both in the univariant analysis (OR = 9.5) and the multivariant (OR = 5.5).…”

Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children

“…In separate studies, children with CD [19] and children with UC [20] were more likely than their unaffected siblings to have had diarrheal illness during infancy. In a large study [21] . In a nested case-control study (26 CD, 29 UC, eight randomly selected controls matched for gender and social class) from two national longitudinal birth cohorts, infections during pregnancy or in childhood were associated with an increased risk of CD and UC, but these differences were not statistically significant [22] .…”

“…Two smaller studies found no association between seasonality of birth, maternal age at birth, birth weight, or birth order and either disease [25,26] . In a study of perinatal factors, the occurrence of any perinatal health event increased the risk of both CD and UC [21] . The occurrence of any noninfectious perinatal event was an independent risk factor for IBD [ψ = 3.5 (2.0-6.3)] as was low socioeconomic status [ψ = 2.7 (1.2-5.7)] and low placental weight [ψ = 1.5 (1.0-2.2)].…”