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Mode of Delivery and Risk of Inflammatory Bowel Disease in the Offspring: Systematic Review and Meta-analysis of Observational Studies

Bruce, Alanna MSc*; Black, Mairead MBchB, MSc; Bhattacharya, Sohinee MBBS, PhD

doi: 10.1097/MIB.0000000000000075
Original Clinical Articles

Background: The incidence of inflammatory bowel disease (IBD) is increasing worldwide; however, pathogenesis is not fully understood. The global cesarean section (CS) rate is also rising, and evidence suggests that mode of delivery may influence colonization of the offspring gut microbiota, predisposing offspring to IBD. This study aimed to investigate the relationship between mode of delivery and risk of IBD.

Methods: The electronic databases, Embase, CINAHL, and Medline (1948 to present) were searched, reference lists were checked, and no restrictions were assigned. Full texts of potentially relevant articles were evaluated, and included articles were assessed for quality. Raw data were used to calculate unadjusted odds ratios reflecting the risk of developing IBD in those delivered by cesarean. A meta-analysis was performed using RevMan 5 software to obtain a pooled measure of effect. Sensitivity analyses were performed to identify results according to specific study designs.

Results: Seven eligible studies were included; 4 were retrospective cohort design and 3 were case-control studies. The total number of children born by CS in the meta-analysis was 1354, and 11,355 were delivered vaginally. The proportion of IBD in the CS group was 0.249% compared with 0.322% in the vaginal delivery group. The pooled odds ratio of developing IBD when delivered by CS was 1.00 (95% confidence interval, 0.75–1.33).

Conclusions: This analysis observed no significant difference in risk of IBD in offspring delivered by CS compared with those born vaginally.

Article first published online 28 May 2014.

*University of Aberdeen Medical School, Aberdeen, United Kingdom; and

Departments of Obstetrics and Gynaecology, and

Epidemiology, University of Aberdeen, Aberdeen, United Kingdom.

Reprints: Mairead Black, MBChB, MSc, Room 3, Dugald Baird Centre, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, United Kingdom (e-mail:

The authors have no conflicts of interest to disclose.

Received April 01, 2014

Accepted April 11, 2014

© Crohn's & Colitis Foundation of America, Inc.
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