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Pre- and perinatal stress and irritable bowel syndrome in young adults - A nationwide register-based cohort study
Ola Olén1,2, Olof Stephansson1, Ann-Sofie Backman1
1Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Insights
Mode of delivery impacts irritable bowel syndrome (IBS) risk in young adults. While not linked to birth weight or neonatal distress, delivery method and female gender are key factors in IBS development.
Area of Science:
- Gastroenterology
- Perinatal Medicine
- Epidemiology
Background:
- The exact causes of irritable bowel syndrome (IBS) remain unclear.
- Early life stress is hypothesized to alter nociceptive pathways, potentially influencing IBS development.
- Conclusive evidence linking early life stress to long-term IBS risk is limited.
Purpose of the Study:
- To investigate the association between pre- and perinatal stress factors and the incidence of irritable bowel syndrome (IBS) in young adulthood.
- To identify specific perinatal events that may increase or decrease the risk of developing IBS.
- To determine the relative importance of various perinatal factors compared to established risk factors like gender.
Main Methods:
- A large-scale population-based cohort study using Swedish national registers.
- Inclusion of all children born between 1973 and 1992.
- Analysis of diagnostic codes for IBS (ICD-10: K58) from specialized outpatient care visits between 2001-2009.
- Multivariable logistic regression to compare IBS incidence based on pre- and perinatal stress indicators.
Main Results:
- The study included over 2 million children, with 14,382 diagnosed with IBS after age 18.
- Neither low nor high birth weight was associated with increased IBS risk.
- Preterm birth showed a slightly reduced IBS occurrence (OR 0.82).
- Instrumental vaginal delivery (OR 1.14) and Cesarean delivery (OR 1.09) were linked to a modest increase in IBS risk.
- Neonatal or respiratory distress did not correlate with future IBS diagnosis.
- Female gender emerged as the strongest predictor of IBS (OR 3.48).
Conclusions:
- Mode of delivery (vaginal instrumental or Cesarean) is associated with an elevated risk of developing IBS in young adulthood.
- Other assessed perinatal stress indicators, such as birth weight and neonatal distress, were not significant risk factors for adult IBS.
- Female gender remains the most significant risk factor for developing IBS.
Background:
The etiology of irritable bowel syndrome (IBS) is poorly understood. Animal and human data suggest that early life stress may induce long-term changes in the nociceptive circuitry, but conclusive studies are lacking.
Methods:
We identified all Swedish children born between 1973 and 1992 in the Swedish Medical Birth Register. We had access to all diagnostic codes for specialized (nonprimary care) outpatient visits 2001-2009 (the National Patient Register) and identified individuals who were diagnosed with IBS (ICD-10 code: K58) after 18 years of age. We compared incidence of IBS in individuals with and without pre- and perinatal stress using multivariable logistic regression.
Key Results:
2 056 430 children were included in the study. After turning 18 years, 14 382 of them were diagnosed with IBS in specialized outpatient care. Neither high, nor low birth weight was a risk factor for IBS in young adults. Preterm birth was associated with lower occurrence of IBS (adjusted OR 0.82 [0.75-0.90]) and vaginal instrumental delivery and Cesarean delivery were associated with slightly increased odds of IBS (adjusted OR 1.14 [1.06-1.24] and 1.09 [1.03-1.16] respectively). Neonatal distress and respiratory distress were not associated with future IBS. Female gender was by far the strongest risk factor for IBS in young adults (adjusted OR 3.48 [3.34-3.63]).
Conclusions & Inferences:
In this large population-based study, we found that mode of delivery was associated with an increased risk for IBS in young adulthood, while other proxies for pre- and perinatal stress were not. Female gender remains the most important risk factor for IBS.
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