Cesarean delivery and risk of inflammatory bowel disease: a systematic review and meta-analysis

Abstract

Objective. It has been considered that cesarean delivery is a risk factor for the two subtypes of inflammatory bowel diseases (IBDs): Crohn’s disease (CD) and ulcerative colitis (UC). The aim of this meta-analysis was to examine the relationship between cesarean delivery and the development of IBD. Material and methods. We searched the articles retrieved by PubMed, MEDLINE and EMBASE databases to identify observational studies regarding the relationship between cesarean section and the development of CD and/or UC. Pooled odds ratios were calculated for each relationship. Results. Nine studies evaluated the potential association between cesarean delivery and the development of IBD and met all of our inclusion criteria. The pooled data from six included studies indicated cesarean delivery was a risk factor for CD (95% confidence interval [CI]: 1.12–1.70; p = 0.003). Likewise, we observed a positive association between cesarean delivery and pediatric CD (95% CI: 1.06–1.35; p = 0.005). However, results from the four included studies for UC indicated the rate of cesarean section in UC patients was not higher than that of control subjects (95% CI: 0.87–1.32; p = 0.54). Overall, we did not observe a positive relationship between cesarean delivery and IBD (95% CI: 0.99–1.30; p = 0.08). Conclusion. Results of this meta-analysis support the hypothesis that cesarean delivery was associated with the risk of CD but not of UC. The total rate of cesarean delivery of IBD patients was similar with that of control subjects.

Key Words::

• cesarean delivery
• Crohn’s disease
• meta-analysis
• risk factor
• ulcerative colitis

Acknowledgments

This study was supported in part by funding from National Ministry of Health for the Digestive Disease (Grant 201002020) and National Natural Science Foundation of China (Grant 81200263, 30972881 and 81170365). The authors would like to thank Dr Liang Zhang (Nanjing University) for his statistical assistant. They are indebted to the authors of the primary studies.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.