C-section babies face a higher risk of Crohn’s disease later in life
Cesarean delivery was associated with a higher risk of developing Crohn’s disease later in life, according to a population-based cohort study in Sweden.
In the study of more than one million newborns, an unadjusted univariate analysis found that certain gastrointestinal disorders were more common among those born by cesarean section, reported Anna Löf Granström, MD, PhD, of Karolinska Institutet in Stockholm, and his colleagues:
- Diverticulosis: HR 1.57 (95% CI 1.13-2.18)
- Cholecystitis: RR 1.16 (95% CI 1.05-1.28)
- Crohn’s disease: RR 1.13 (95% CI 1.02-1.25)
But after adjusting for confounders, the risk remained higher only for Crohn’s disease (HR 1.14, 95% CI 1.02-1.27), according to the results of Acta Obstetricia and Gynecologica Scandinavica.
In subgroup analysis, those born by elective caesarean section had an even higher risk of Crohn’s disease both in univariate analysis (HR 1.16, 95% CI 1.01-1.34) and in multivariate (HR 1.18, 95% CI 1.01-1.37) for vaginal deliveries. . Although emergency caesarean sections were associated with an increased risk of diverticulosis and cholecystitis in univariate analysis, they both lost significance in adjusted multivariate analysis.
“Our study is the largest in this area, showing interesting new associations between cesarean section and increased risk later in life for Crohn’s disease,” Granström said in a press release. “We hypothesize that the underlying mechanism could be the gut microbiome, but further studies will need to confirm this.”
Multivariate analysis showed no significant relationship between mode of delivery and ulcerative colitis, appendicitis, diverticulosis or cholecystitis.
Cesarean deliveries have increased and account for up to 20% of all births worldwide, Granström’s group noted. Previous studies have shown that caesarean sections are linked to an increased risk of infection and disease in infants, as well as other conditions that can occur later in life, especially in women.
“There are observations suggesting that early aberrations in the gut microbiota may have lasting consequences that have been linked to an increased risk of asthma, allergies, type 1 diabetes, celiac disease and immune deficiencies, which may suggest an increased risk of inflammation-mediated disease,” the authors noted.
“Infants born via vaginal delivery are primarily colonized with bacteria from the birth canal, consisting of bacterial flora primarily from the intestinal tract, unlike infants born via caesarean section. [C-section]which have an increased prevalence of skin flora when first colonized,” they wrote. “Disturbed intestinal colonization (dysbiosis) in a newborn can be explained by cesarean delivery, use of perinatal antibiotics and type of diet (breast milk or formula). “
Granström and colleagues looked at medical birth registry data on 1,102,468 newborns born at term (37 to 42 weeks gestation) from 1990 to 2000 in Sweden. Of these, 88.4% were delivered vaginally and 11.6% by Caesarean section. Caesarean sections were stratified by urgency (56.2%) or elective procedures (43.8%). Follow-up took place until the end of 2017. Excluded are children from multiple pregnancies or unknown modes of delivery.
Analysis adjusted for birth weight, gestational age, small-for-gestational age, perinatal disease, congenital malformations, maternal smoking, and highest parental education.
The C-section group was more often male (53% vs. 51%) and born earlier (median gestational age 38 vs. 40 weeks) with a lower predicted birth weight (approximately 7 vs. 8 lbs), compared to the group vaginal birth. In addition, the caesarean group was born to mothers who were slightly older (mean age 30 years versus 28.5 years) and more often smokers (18.3% versus 17.3%).
Not surprisingly, the C-section group suffered from more perinatal illnesses (19.2% versus 5.2%), birth defects (6.3% versus 3.5%) and death (1.9% versus 0). .8%).
The median time to diagnosis of gastrointestinal disorders for the cesarean section and vaginal delivery groups, respectively, was: appendicitis (15.1 versus 15.3 years), Crohn’s disease (16.9 versus 17 ,4 years), ulcerative colitis (17.8 vs 18.2 years) and cholecystitis (20.8 vs 21 years).
Limitations of the study included that registry-based data may be subject to residual confounding. Additionally, no information was available on hereditary factors, BMI, use of perinatal antibiotics, or whether newborns were breastfed or formula-fed.
The study was supported by the Bengt Ihre Research Fellowship.
Granström revealed support from Stockholm County Council.