Having a mother with a diagnosis of inflammatory bowel disease (IBD), being in the highest socioeconomic quintile at birth, and having an infection in the first year of life increases the risk of developing IBD, according to a study published in Gastroenterology.
Investigators conducted an administrative database, population-based study to determine if there was an increased risk for IBD diagnosis in infants with critical events at birth through 1 year of age. For this, researchers collected data from the University of Manitoba IBD Epidemiology Database, for all residents of Manitoba diagnosed with IBD from 1984 through 2010 (n=825) and matched controls (n=5999). The incident rates of infections, gastrointestinal illnesses, and failure to thrive (as identified by outpatient visits and hospitalizations) were analyzed and compared for patients with and controls, as well as patients with IBD and their siblings. Neonatal events were also analyzed.
The administrative health records of 1671 patients with IBD, 1740 siblings, and 10,488 matched controls were linked to their mothers, dating back to 1970. A total of 6824 participants had events that could be examined back to 1979. The IBD cases in the database were diagnosed <10 years of age (n=97), between ages 10 and 20 years (n=499), and >20 years of age (n=229). The strongest predictor for developing IBD later in life in all models was the maternal history of IBD (odds ratio [OR] 4.53; 95% confidence interval [CI], 3.08-6.67). In the models assessing all neonatal events and events within the first year of life, later development of IBD at any age was in the highest or second highest socioeconomic quintile at birth compared with the lowest quintile (OR 1.35; 95% CI, 1.01-1.79 and OR 1.37; 95% CI, 1.06-1.77, respectively) and infections within the first year of life (OR 1.39; 95% CI, 1.09-1.79). Hospitalization for infections did not prove to be a significant predictor for developing IBD.
The limitations of this study include the inability to assess definitively which conditions were associated with antibiotic prescriptions for children with infections, so the association with the ultimate diagnosis of IBD at all ages is therefore speculative. It is possible that other factors are as much or more important in the first year of life in increasing the risk of developing IBD later in life, such as diet or duration of breastfeeding. Other household environmental factors, including smoking, may also contribute to the increased risk for IBD. However, the strongest findings of this study were the associations between infection in the first year of life and childhood-onset IBD.
Infection in the first year of life, but not neonatal health status, can predict later development of IBD. No increased risk was found when compared with siblings, but the risk existed when compared with controls, which suggests that noncommunal environmental factors may be important in the pathogenesis of IBD.
Given these findings, clinicians should exercise more caution when prescribing antibiotics for very young children. Because passive immunity decreases during the first year of life, there is the potential for a greater use of antibiotics among younger siblings.
Future studies should explore the childhood household environment in persons who develop IBD compared with those who do not, as well as the infant gut microbiome before and for several months after infections with and without antibiotic use to determine what changes might occur to promote the development of IBD later in life.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Bernstein CN, Burchill C, Targownik LE, Singh H, Roos LL. Events within the first year of life, but not the neonatal period, affect risk for later development of inflammatory bowel diseases. Gastroenterology. 2019;156(8):2190-2197