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Perinatal and Antibiotic Exposures and the Risk of Developing Childhood-Onset Inflammatory Bowel Disease: A Nested
Cristina Canova1, Jonas F Ludvigsson2,3,4,5, Riccardo Di Domenicantonio6
1Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy.
Insights
Frequent antibiotic use in infancy significantly increases the risk of developing childhood Inflammatory Bowel Disease (IBD). Perinatal factors showed no association with IBD onset in this study.
Area of Science:
- Pediatrics
- Gastroenterology
- Environmental Health
Background:
- The environmental factors influencing childhood Inflammatory Bowel Disease (IBD) onset are not fully understood.
- Early-life exposures are critical in immune system development and disease susceptibility.
Purpose of the Study:
- To investigate the association between perinatal conditions and early-life antibiotic exposure with the risk of childhood-onset IBD.
- To quantify the impact of these exposures on IBD development in a large birth cohort.
Main Methods:
- A nested case-control study was conducted within a longitudinal cohort of 213,515 newborns in Friuli-Venezia Giulia, Italy.
- Conditional binomial regression models were used to analyze risk factors for IBD onset before age 18.
- 164 IBD cases and 1640 controls were identified and analyzed.
Main Results:
- No significant association was found between perinatal conditions and childhood IBD.
- Children with four or more antibiotic prescriptions in the first year of life had a significantly higher risk of IBD (OR=6.34 at 6 months, OR=2.91 at 12 months).
- This association was particularly noted in Crohn's disease patients and those with earlier IBD onset.
Conclusions:
- Perinatal factors do not appear to be associated with childhood IBD.
- Frequent antibiotic use in the first year of life is linked to an increased risk of developing childhood-onset IBD, especially Crohn's disease.
Abstract:
The role of early-life environmental exposures on Inflammatory Bowel Disease (IBD) onset remains unclear. We aimed to quantify the impact of perinatal conditions and antibiotic use in the first 6 and 12 months of life, on the risk of childhood-onset IBD, in a birth cohort of the region Friuli-Venezia Giulia (Italy). A nested case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate Odds Ratios (OR) with 95% confidence intervals (CI) for all analyzed risk factors. We identified 164 individuals with IBD onset before the age of 18 years and 1640 controls. None of the considered perinatal conditions were associated with IBD. Analyses on antibiotic exposure were based on 70 cases and 700 controls. Risks were significantly higher for children with ≥4 antibiotic prescriptions in the first 6 and 12 months of life (OR = 6.34; 95%CI 1.68-24.02 and OR = 2.91; 95%CI 1.31-6.45, respectively). This association was present only among patients with Crohn's disease and those with earlier IBD onset. We found that perinatal characteristics were not associated to IBD, while the frequent use of antibiotics during the first year of life was associated to an increased risk of developing subsequent childhood-onset IBD.
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