Cesarean delivery and risk of inflammatory bowel disease: a systematic review and meta-analysis

Scand J Gastroenterol. 2014 Jul;49(7):834-44. doi: 10.3109/00365521.2014.910834. Epub 2014 Jun 18.


Objective: It has been considered that cesarean delivery is a risk factor for the two subtypes of inflammatory bowel diseases (IBDs): Crohn's disease (CD) and ulcerative colitis (UC). The aim of this meta-analysis was to examine the relationship between cesarean delivery and the development of IBD.

Material and methods: We searched the articles retrieved by PubMed, MEDLINE and EMBASE databases to identify observational studies regarding the relationship between cesarean section and the development of CD and/or UC. Pooled odds ratios were calculated for each relationship.

Results: Nine studies evaluated the potential association between cesarean delivery and the development of IBD and met all of our inclusion criteria. The pooled data from six included studies indicated cesarean delivery was a risk factor for CD (95% confidence interval [CI]: 1.12-1.70; p = 0.003). Likewise, we observed a positive association between cesarean delivery and pediatric CD (95% CI: 1.06-1.35; p = 0.005). However, results from the four included studies for UC indicated the rate of cesarean section in UC patients was not higher than that of control subjects (95% CI: 0.87-1.32; p = 0.54). Overall, we did not observe a positive relationship between cesarean delivery and IBD (95% CI: 0.99-1.30; p = 0.08).

Conclusion: Results of this meta-analysis support the hypothesis that cesarean delivery was associated with the risk of CD but not of UC. The total rate of cesarean delivery of IBD patients was similar with that of control subjects.

Keywords: Crohn’s disease; cesarean delivery; meta-analysis; risk factor; ulcerative colitis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Cesarean Section / adverse effects*
  • Child
  • Colitis, Ulcerative / etiology*
  • Crohn Disease / etiology*
  • Female
  • Humans
  • Odds Ratio
  • Pregnancy
  • Risk Factors