MODE OF DELIVERY AND RISK OF INFLAMMATORY BOWEL DISEASE
Neeraj Narula*2, Catarina F. Gomes1, Barbara Morão1, Paulo Nicola3, Joana Torres1
1Hospital Beatriz Ângelo, Lisbon, Portugal; 2McMaster University, Ontario, ON, Canada; 3Faculty of Medicine of Lisbon, Lisbon, Portugal
Background: Recent evidence suggests that exposures in early life that are known to influence microbiome development (eg. breastfeeding, exposure to antibiotics, etc) may affect the risk of developing IBD. Mode of delivery is one of the major factors impacting the newborn's microbiome development, and specifically, Cesarian-section (C-section), which has been associated with altered colonization of commensal gut flora, is thought to predispose to immune-mediated diseases later in life. The relation between C-section and IBD is not yet well characterized with different studies showing conflicting results. Purpose: Performe a meta-analysis 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 Scopus. Case-control and cohort studies were included. 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. Heterogeneity between the studies was assessed. Publication bias was evaluated by funnel plots and Egger's test. Study's quality was characterized using the Newcastle Ottawa Scale (NOS). Analysis was conducted using Comprehensive Meta-Analysis v2. Results: 11 studies fulfilled the inclusion criteria, of which 6 were population-based. All the studies were from developed countries (UK, Denmark, Australia, USA, Germany, Canada, Scotland, Norway, Sweden) and 5 were limited to paediatric age (< 16 years old). No publication bias was detected. Overall, the total number of IBD patients was 15,292 and 6,981,080 controls. Being born by C-section was not associated with a higher risk of IBD (OR 1,02 [95% CI 0,84 - 1,24], p=0,86). We observed a trend towards an increased risk for CD in individuals born by C-section compared to those vaginally delivered, without significant results (OR 1,39 [95% CI 0,99 - 1,71], p=0,06). No association was found between C-section and UC (OR 0,99 [95% CI 0,76 - 1,30], p=0,94). No differences were found in IBD risk when comparing elective and emergent C-section (OR 1,05, [95% CI 0,59 - 1,87], p=0,87). Conclusion: Overall, the risk of developing IBD was not affected by mode of delivery. Likewise, the setting of C-section (emergent vs elective) did not affect IBD risk. Individuals born by C-section may have a higher risk for CD.
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