Maternal Crohn’s disease ups risk of infection in offspring

Offspring born to mothers with Crohn’s disease (CD), but not ulcerative colitis, are at higher risk of infection, suggests a study. This association is partly mediated by adverse birth outcomes and antitumour necrosis factor α (anti-TNFα) agents.

“The association between anti-TNFα agents and paediatric infection could be partially explained by maternal CD,” the authors said.

A total of 1,343,960 live-born singletons born in Denmark from 1995 to 2016 were included in this population-based study, with maternal inflammatory bowel disease (IBD) as the exposure. The authors assessed offspring infection at <5 years of age, defined by either infection-related hospitalization or systemic antibiotic prescription. An inverse probability-weighted marginal structural model was used for mediation analysis.

Maternal CD was associated with an 18-percent increased risk of offspring infection-related hospitalization (hazard ratio, 1.18, 95 percent confidence interval [CI], 1.10‒1.26) and a 16-percent increased frequency of prescribed antibiotics (incidence rate ratio [IRR], 1.16, 95 percent CI, 1.11‒1.21).

Notably, anti-TNFα agents accounted for 10 percent of 3 percent of the two estimated total associations, respectively, while a composite of preterm birth, low birth weight, and small for gestational age was responsible for 4 percent and 0 percent, respectively.

Additional adjustment for maternal CD attenuated the association between prenatal anti-TNFα and frequency of antibiotics (IRR, from 1.23, 95 percent CI, 0.98‒1.55 to 1.10, 95 percent CI, 0.87‒1.40).

On the other hand, maternal ulcerative colitis showed no association with offspring infection.