title: Preterm birth but not mode of delivery is associated with an increased risk of developing inflammatory bowel disease later in life.
abstract: BACKGROUND
  Exposure to bacterial antigens and other environmental factors in combination with a genetic susceptibility have been implicated in the etiology of inflammatory bowel disease (IBD). As certain perinatal circumstances, e.g., delivery by cesarean section, predispose to a different intestinal colonizations the aim of this analysis was to define a potential influence on the development of IBD in later life.
  
  
  METHODS
  In a case-control study design, birth data were recorded from patients diagnosed with IBD (Crohn's disease [CD], n = 1,096; ulcerative colitis [UC], n = 763) and healthy controls ([C], n = 878) by a self-administered questionnaire.
  
  
  RESULTS
  Preterm birth (CD: odds ratio [OR] 1.5 [95% confidence interval 1.1-2.0], UC: OR 1.3 [0.9-1.9]), mother's disease during pregnancy (CD: OR 1.9 [1.3-2.9], UC: OR 1.6 [1.0-2.4]), and disease in the first year of life (CD: OR 2.2 [1.6-2.9], UC: OR 1.7 [1.3-2.3]) are associated with the development of IBD in later life. No significant associations were found for the mode of delivery and breast feeding. In a logistic regression analysis female sex, smoking, appendectomy, maternal IBD, and disease in the first year of life were independently associated with CD. Female sex, appendectomy, and disease in the first year of life were independently associated with UC.
  
  
  CONCLUSIONS
  Preterm birth and other perinatal circumstances are associated with the development of IBD, of which disease in the first year of life is an independent risk factor in multivariate analysis.
authors.affiliation: Department of Obstetrics and Gynecology, University of Muenster, Muenster, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sonntag
authors.forename: Birgit
authors.initials: B
authors.lastname: Stolze
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Andreas
authors.initials: A
authors.lastname: Luegering
authors.forename: Jan
authors.initials: J
authors.lastname: Heidemann
authors.forename: Pia
authors.initials: P
authors.lastname: Lebiedz
authors.forename: Emile
authors.initials: E
authors.lastname: Rijcken
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kiesel
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Torsten
authors.initials: T
authors.lastname: Kucharzik
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
mesh_terms: D000328:Adult; D001724:Birth Weight; D001942:Breast Feeding; D016022:Case-Control Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000209:etiology*; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D047928:Premature Birth; D012307:Risk Factors; D011795:Surveys and Questionnaires