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Prematurity, Delivery Method, and Infant Feeding Type Are Not Associated with Paediatric-onset Inflammatory Bowel
Christopher J Burgess1,2, Christian Schnier3, Rachael Wood4,5
1Child Life and Health, University of Edinburgh, Edinburgh, UK.
Insights
This study found no link between birth factors like delivery mode, gestational age, or infant feeding type and the development of paediatric-onset inflammatory bowel disease (PIBD). These findings suggest other factors may be involved in PIBD development.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Immunology
Background:
- Paediatric-onset inflammatory bowel disease (PIBD) incidence is increasing globally.
- Understanding risk factors for PIBD is crucial for early intervention and prevention strategies.
Purpose of the Study:
- To investigate the association between mode of delivery, gestational age at birth, and infant feeding type with the risk of developing PIBD.
- To analyze these factors within a large, nationwide cohort of Scottish children.
Main Methods:
- Utilized linked health administrative data for all children born in Scotland (1981-2017).
- Defined PIBD cases as Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU) before age 16.
- Employed Cox proportional hazards models to calculate hazard ratios (HR) for various exposures, with case-note verification for accuracy.
Main Results:
- A cohort of 2,013,851 children included 1721 PIBD cases; 93% of validated cases were true positives.
- No significant difference in PIBD risk was observed for children born vaginally versus by C-section (aHR 0.95).
- Premature birth (24-31 weeks: aHR 0.99; 32-36 weeks: aHR 0.96) and exclusive formula feeding at 6 weeks (aHR 0.97) were not associated with altered PIBD risk compared to term birth and exclusive breastfeeding, respectively.
Conclusions:
- This large population-based study found no evidence linking mode of delivery, gestational age, or exclusive formula feeding at 6 weeks to the development of PIBD.
- The findings indicate that these specific perinatal and early infant factors do not appear to be major contributors to PIBD risk in the studied population.
Background And Aims:
The incidence of paediatric-onset inflammatory bowel disease [PIBD] continues to rise globally. We aimed to determine whether mode of delivery, gestational age at birth, or type of infant feeding contribute to the development of PIBD in a nationwide cohort of Scottish children.
Methods:
All children born in Scotland between 1981 and 2017 were identified using linked health administrative data to determine mode of delivery, gestational age at birth, and type of infant feeding. PIBD cases were defined as onset of Crohn's disease [CD], ulcerative colitis [UC], or IBD-unclassified [IBDU] before age 16 years. Validation was performed within an entire Scottish health board [16% of total population] via individual case-note verification. Hazard ratios [HR] were calculated for each exposure using Cox proportional hazards models.
Results:
A study population of 2 013 851 children was identified including 1721 PIBD cases. Validation of 261 PIBD patients coded as CD and/or UC identified 242 [93%] as true positive. Children delivered vaginally did not have an altered risk of developing PIBD compared with those delivered by caesarean section, adjusted HR 0.95 [95% CI 0.84-1.08] [p = 0.46]. Compared with children born at term [≥37 weeks], children born prematurely did not have an altered risk of developing PIBD, i.e., at 24-31 weeks of gestation, HR 0.99 [95% CI 0.57-1.71] [p = 0.97] and at 32-36 weeks of gestation, HR 0.96 [95% CI 0.76-1.20] [p = 0.71]. Compared with children exclusively breastfed at age 6 weeks, children exclusively formula fed did not have an altered risk of developing PIBD: adjusted HR 0.97 [95% CI 0.81-1.15] [p = 0.69].
Conclusions:
This population-based study demonstrates no association between mode of delivery, gestational age, or exclusive formula feeding at 6 weeks, and the development of PIBD.
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