Iron supplements, vaccines in early life may reduce later IBD risk

WASHINGTON — Oral iron supplementation during infancy and diphtheria and polio vaccination appeared to reduce the risk for developing inflammatory bowel disease later in life, according to a presenter here.

Perspective from Joel R. Rosh, MD, FAAP, FACG, AGAF

The investigators also found that smoking and antibiotic use during pregnancy appeared to increase the risk for Crohn’s disease in children, while breastfeeding appeared protective.

To study the role of prenatal, pregnancy- and infancy-related risk factors for IBD, Jukka Ronkainen, MD, PhD, of the University of Oulu in Finland, and colleagues evaluated longitudinal data on more than 12,000 mothers and their children from the Northern Finland Birth Cohort spanning back to 1966.

“[Our] hypothesis was that pregnancy period and first year of life family history, social relationships, environment and mother’s health-related factors during pregnancy, and infant’s health during first year may be risk factors for development of IBD later in life,” Ronkainen said during his presentation.

Of the 7,077 children for whom medical data were available, 157 (2.2%) were diagnosed with IBD, including 113 (1.6%) with ulcerative colitis and 44 (0.6%) with Crohn’s disease.

The investigators found the following significant associations:

Smoking during pregnancy and higher IBD risk (OR = 1.6; 95% CI, 1-2.3);
Antibiotic use during pregnancy and higher Crohn’s risk (OR = 2.9; 95% CI, 1.4-6);
Oral iron supplementation during infancy and lower IBD risk (OR = 0.6; 95% CI, 0.4-0.8; P = .0005);
Diphtheria, tetanus and pertussis vaccination (DTP) and lower IBD risk (OR = 0.6; 95% CI, 0.4-0.9; P = 0.01); and
Polio vaccination and lower IBD risk (OR = 0.7; 95% CI, 0.5-1; P = 0.03).

The protective effects of early iron supplementation were “quite strong both for Crohn’s disease and ulcerative colitis,” Ronkainen said. Breastfeeding was not associated with IBD overall but appeared to have a protective effect against Crohn’s disease, he noted. – by Adam Leitenberger

Reference:

Blomster T, et al. Abstract 56. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Ronkainen reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

Perspective

Joel R. Rosh, MD, FAAP, FACG, AGAF

This was a fantastic treasure trove of epidemiologic data. The investigators’ numbers looked good, there were 12,000 participants in this registry but only 7,000 gave consent and of that, only 157 developed inflammatory bowel disease. So, keep in mind that we are really looking at 157 patients with IBD. In that relatively small group, there were some interesting findings. If we look at maternal exposures, the mother’s age, the gestational age of the child, and the maternal parity all were not associated with the development of IBD. Interestingly another exposure that has been shown in other studies was not supported by this data and that was urban lifestyle vs. life on the farm.

What was supported by this data set was that if mother smoked during pregnancy, or interestingly with an OR of almost 3, if the mother took antibiotics during the pregnancy, there was a higher risk for inflammatory bowel disease in the child. This fits in with our model of alterations in the gut microbiome leading to Chron’s disease and we have seen antibiotic exposure data in the past, but this is looking at the mother’s exposure to antibiotics. However, if the child took antibiotics during the first year of life, that was not associated with IBD whereas other studies have shown that it does. Now we have data on both sides of the fence, as far as childhood exposure to antibiotics. What was shown to be protective for the development of IBD is that if the mother had iron supplementation and if the child had regular vaccines, it seemed to decrease the risk. Of course, these are only associations and one could wonder if that means better health care, better access, there’s a lot of questions why vaccines would actually be associated with a protective effect, but it is notable that iron supplementation and regular vaccine administration seem to be protective against IBD.

Joel R. Rosh, MD, FAAP, FACG, AGAF

Director, Pediatric Gastroenterology

Vice Chairman, Clinical Development and Research Affairs

Goryeb Children's Hospital

Professor of Pediatrics

Icahn School of Medicine at Mount Sinai

Disclosures: Rosh reports serving as a consultant or advisor to AbbVie, Celgene, Eli Lilly, Janssen, Luitpold Pharmaceuticals and Pfizer. Rosh additionally reports research support through AbbVie and Janssen.