Issue 07

Clinical Question

Does maternal antibiotic use increase risk of childhood IBD?

Editor’s Bottom Line

This analysis suggests an interesting relationship between maternal antibiotic use in pregnancy and very early onset IBD among infants. However, the number of cases is small and confirmation of this finding in other data sets would be informative.

Reference

Örtqvist AK, Lundholm C, Halfvarson J, et al. Fetal and early life antibiotics exposure and very early onset inflammatory bowel disease: a population-based study. Gut. 2019;68:218–25; http://dx.doi.org/10.1136/gutjnl-2017-314352

Synopsis

To document a possible link between maternal exposure to systemic antibiotics during pregnancy and very early-onset IBD prior to six years of age, Swedish researchers examined data from 827,239 children born in that country between 2006 and 2013. They turned to two nationwide registries to document antibiotic use, IBD diagnoses and potentially confounding variables such as parental IBD diagnosis and early life gastroenteritis, as well as antibiotic exposure during infancy.

The authors identified 51 cases of very early onset IBD in the cohort and found that children whose mothers used antibiotics during pregnancy had a nearly two-fold increased risk of IBD diagnosis before six years of age, compared to similarly aged children in the general population (adjusted Hazard Ratio: [aHR], 1.93; 95% Confidence Interval [CI]: 1.06–3.50). The risk for Crohn’s disease was higher (aHR: 2.48; 95% CI: 1.01–6.08) than for ulcerative colitis (aHR:  1.25 (95% CI: 0.47–3.26).

When analyses excluded six children with IBD who had a diagnosis of gastroenteritis within one year prior to their IBD diagnosis, the association between maternal exposure to systemic antibiotics and the risk of very early onset IBD lost its statistical significance. The researchers did not find a correlation between infantile exposure to antibiotics and IBD risk.

The authors said the findings are limited by the small sample size of IBD patients and potential misclassification of diagnoses.

Details

Study Design: Retrospective cohort
Funding: The Swedish Research Council
Allocation: Not applicable
Setting: Nationwide registry
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.