Journal Article

Fetal and early life antibiotics exposure and very early onset inflammatory bowel disease: a population-based study

Örtqvist, Anne K, Almqvist, Catarina, Ludvigsson, Jonas F, Lundholm, Cecilia, Halfvarson, Jonas

2019

Overview

ObjectiveEarlier studies on antibiotics exposure and development of IBD (Crohn’s disease (CD) and ulcerative colitis (UC)) may have been biased by familial factors and gastroenteritis. We aimed to estimate the association between antibiotics during pregnancy or infantile age and very early onset (VEO) IBD.DesignIn this cohort study of 827 239 children born in Sweden between 2006 and 2013, we examined the link between exposure to systemic antibiotics and VEO-IBD (diagnosis <6 years of age), using Cox proportional hazard regression models. Information on antibiotics and IBD was retrieved from the nationwide population-based Swedish Prescribed Drug Register and the National Patient Register. We specifically examined potential confounding from parental IBD and gastroenteritis.ResultsChildren exposed to antibiotics during pregnancy were at increased risk of IBD compared with general population controls (adjusted HR (aHR) 1.93; 95% CI 1.06 to 3.50). Corresponding aHRs were 2.48 (95% CI 1.01 to 6.08) for CD and 1.25 (95% CI 0.47 to 3.26) for UC, respectively. For antibiotics in infantile age, the aHR for IBD was 1.11 (95% CI 0.57 to 2.15); for CD 0.72 (95% CI 0.27 to 1.92) and 1.23 (95% CI 0.45 to 3.39) for UC. Excluding children with gastroenteritis 12 months prior to the first IBD diagnosis retained similar aHR for antibiotics during pregnancy and CD, while the association no longer remained significant for IBD.ConclusionWe found that exposure to antibiotics during pregnancy, but not in infantile age, is associated with an increased risk of VEO-IBD regardless of gastroenteritis. The risk increase for exposure in pregnancy may be due to changes in the microbiota.

• Publisher: BMJ Publishing Group LTD
• Subject: Age / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - adverse effects / Antibiotics / Antimicrobial agents / Appendectomy / Child, Preschool / Children / Crohn's disease / crohn’s colitis / Diagnosis / Drug resistance / epidemiology / Female / Fetus - drug effects / Fetuses / Gastroenteritis / Gastrointestinal Microbiome - drug effects / Genetics / Health risk assessment / Humans / Infant / Infant, Newborn / Inflammatory bowel disease / Inflammatory bowel diseases / Inflammatory Bowel Diseases - chemically induced / Inflammatory Bowel Diseases - epidemiology / Intestine / Male / Microbiota / Population / Population studies / Population-based studies / Pregnancy / Registries / Regression analysis / Risk Factors / Sweden - epidemiology / Ulcerative colitis