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A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development
Published on: June 24, 2020
Prenatal and perinatal characteristics associated with pediatric-onset inflammatory bowel disease
Susan Hutfless1, De-Kun Li, Melvin B Heyman
1Division of Gastroenterology and Hepatology, Johns Hopkins University, 600 N. Wolfe St., Blalock Building 449, Baltimore, MD 21287, USA. shutfle1@jhmi.edu
Insights
Maternal inflammatory bowel disease (IBD) and white race are linked to pediatric IBD risk. This study identified key factors by accounting for confounding in early life risk assessments.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Genetics and Genomics
Background:
- Early life risk factors for pediatric inflammatory bowel disease (IBD) often lack confounding analysis, leading to inaccurate findings.
- Previous studies have not adequately addressed confounding variables in identifying IBD risk factors.
- Robust identification of pediatric IBD risk factors requires accounting for potential confounders.
Purpose of the Study:
- To investigate the association between prenatal and perinatal factors and the risk of pediatric-onset IBD.
- To rigorously assess risk factors by controlling for potential confounding variables.
- To clarify the relationship between maternal and infant characteristics and IBD development.
Main Methods:
- A nested case-control study design was employed.
- Included 189 pediatric IBD cases (age ≤18) and 3,080 matched controls.
- Utilized conditional logistic regression on electronic health records for analysis.
Main Results:
- Maternal history of IBD (OR 5.1) and white race (OR 2.3) were significantly associated with pediatric IBD.
- Maternal respiratory infection, maternal age <20, and gestational hypertension showed non-significant associations.
- The study identified statistically significant risk factors after accounting for confounding.
Conclusions:
- Maternal IBD history and race are key factors associated with pediatric IBD development.
- The findings are based on a well-documented cohort with confirmed diagnoses.
- This research provides a more accurate understanding of pediatric IBD etiology.
Background:
The majority of studies that report early life risk factors for pediatric-onset inflammatory bowel disease (IBD) do not account for potential confounding, which can lead to spurious associations and incorrect inferences.
Aims:
To assess the relationship between prenatal and perinatal characteristics and the risk of pediatric-onset IBD accounting for potential confounding.
Methods:
We conducted a nested case-control study of 189 cases aged ≤18 years and 3,080 age- and membership-matched controls born at a Kaiser Permanente Northern California facility between 1984 and 2006. The cases were diagnosed with IBD between 1996 and 2006 and diagnosis was confirmed by chart review. We obtained prenatal and perinatal characteristics from the electronic clinical records of the mother and child. Conditional logistic regression was used to assess the associations between these factors and risk of incident IBD, Crohn's disease, and ulcerative colitis.
Results:
In analyses accounting for confounding, maternal IBD (odds ratio [OR] 5.1, 95 % confidence interval [CI] 2.0-12.9) and white race (OR 2.3, 95 % CI 1.6-3.2) were the only factors statistically associated with pediatric-onset IBD. Maternal respiratory infection during pregnancy (OR 2.0, 95 % CI 1.0-4.0), age < 20 years (OR 2.0, 95 % CI 0.8-4.7) and gestational hypertension (OR 1.7, 95 % CI 1.0-2.7) were associated with pediatric-onset IBD, but did not achieve statistical significance.
Conclusions:
Maternal history of IBD and race were the only characteristics of those that we examined that were associated with the development of pediatric IBD in this well-documented population of cases and matched controls.
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