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

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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
Original languageEnglish
Pages (from-to)1217–1226
Number of pages10
JournalInflammatory Bowel Diseases
Issue number7
Publication statusPublished - Jul 2014



  • Crohn's Disease
  • Ulcerative colitis
  • Epidemiology

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