分娩方式并不影响炎症性肠病的风险。

Mode of Delivery Does Not Affect the Risk of Inflammatory Bowel Disease.

机构信息

Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal.

Gastroenterology Division, Medicine Department, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.

出版信息

Dig Dis Sci. 2021 Feb;66(2):398-407. doi: 10.1007/s10620-020-06204-7. Epub 2020 Mar 21.

DOI:10.1007/s10620-020-06204-7

PMID:32200523

Abstract

BACKGROUND

Recent evidence suggests that exposures in early life that are known to influence microbiome development may affect the risk of developing inflammatory bowel disease (IBD). Cesarean section has been associated with altered colonization of commensal gut flora and is thought to predispose to immune-mediated diseases later in life.

AIMS

To evaluate the risk of IBD, Crohn's Disease (CD), and Ulcerative Colitis (UC) according to mode of delivery (C-section vs vaginal delivery).

METHODS

A systematic search was performed in PubMed and Embase. The primary outcome was the risk of IBD in individuals delivered vaginally compared to those born by C-section. Secondary outcomes were UC and CD risk according to mode of delivery and IBD risk in individuals born by emergent compared to elective C-section. Publication bias was evaluated by funnel plots and Egger's test. Study's quality was characterized using the Newcastle-Ottawa Scale.

RESULTS

Ten studies fulfilled the inclusion criteria, of which seven were population-based. No publication bias was detected. Overall, 14.164 IBD patients and 4.206.763 controls were included. Being born by C-section was not associated with increased risk of IBD [OR 1.01, 95% CI (0.81-1.27), p = 0.92], CD [OR 1.15, 95% CI (0.94-1.42), p = 0.18] or UC [OR 0.94, 95% CI (0.61-1.45), p = 0.79]. No differences were found between emergent and elective C-section in IBD [OR 1.05, 95% CI (0.59-1,87), p = 0.87]. Substantial heterogeneity was found in statistical analysis, and further studies are needed.

CONCLUSION

Overall, the risk of developing IBD was not affected by mode of delivery.

摘要

背景

最近的证据表明，已知会影响微生物组发育的生命早期暴露可能会影响炎症性肠病（IBD）的发病风险。剖宫产与共生肠道菌群定植的改变有关，并被认为易导致生命后期的免疫介导性疾病。

目的

评估分娩方式（剖宫产与阴道分娩）与 IBD、克罗恩病（CD）和溃疡性结肠炎（UC）发病风险的关系。

方法

在 PubMed 和 Embase 中进行系统检索。主要结局是阴道分娩与剖宫产分娩相比，IBD 的发病风险。次要结局是根据分娩方式评估 CD 和 UC 的发病风险，以及紧急剖宫产与择期剖宫产相比，IBD 的发病风险。通过漏斗图和 Egger 检验评估发表偏倚。采用纽卡斯尔-渥太华量表评价研究质量。

结果

符合纳入标准的研究有 10 项，其中 7 项为基于人群的研究。未发现发表偏倚。共有 14164 例 IBD 患者和 4206763 例对照纳入分析。剖宫产分娩与 IBD 发病风险增加无关[OR 1.01，95%CI（0.81-1.27），p=0.92]、CD[OR 1.15，95%CI（0.94-1.42），p=0.18]或 UC[OR 0.94，95%CI（0.61-1.45），p=0.79]。紧急与择期剖宫产分娩在 IBD 发病风险方面无差异[OR 1.05，95%CI（0.59-1.87），p=0.87]。在统计学分析中发现了显著的异质性，需要进一步的研究。