Meta-analysis of over 13 million births shows no association between Cesarean section and inflammatory bowel disease risk
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Key Takeaway
Note that adjusted meta-analysis data show no association between Cesarean section and inflammatory bowel disease risk in offspring.
This systematic review and meta-analysis examined the association between mode of birth, specifically Cesarean section versus vaginal delivery, and the risk of developing inflammatory bowel disease (IBD), Crohn's disease, and ulcerative colitis in offspring. The study pooled data from observational studies involving over 13 million births. The primary outcome assessed was the risk of IBD, with secondary outcomes focusing on specific subtypes.
In unadjusted analyses, Cesarean section was not associated with overall IBD risk (RR: 0.98; 95% CI: 0.88–1.08) or Crohn's disease (RR: 0.99; 95% CI: 0.88–1.12). However, an inverse association was observed for ulcerative colitis (RR: 0.82; 95% CI: 0.72–0.95). When adjusting for confounders, the association with overall IBD became neutral (HR: 1.14; 95% CI: 0.99–1.30), and no significant associations were found for Crohn's disease or ulcerative colitis.
The study included only observational research, which inherently limits the ability to infer causation. No publication bias was detected, and no adverse events or safety data were reported. While the large sample size strengthens the statistical power, the observational nature of the included studies means these results describe associations rather than causal effects. These findings support current understanding that epidemiological evidence does not support Cesarean section as an independent risk factor for IBD.
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View Original Abstract ↓
BackgroundCesarean section (CS) rates continue rising worldwide, raising concerns about long-term offspring health consequences, including inflammatory bowel disease (IBD). This systematic review and meta-analysis evaluate the association between CS and risk of IBD, Crohn's disease (CD), and ulcerative colitis (UC).MethodsPubMed, Scopus, CENTRAL, and Web of Science were searched through June 2025. Eligible studies included observational cohorts and case-control studies reporting CS vs. vaginal delivery (VD) and IBD outcomes. Data extraction and risk of bias assessment were performed independently. Pooled relative risks (RRs), hazard ratios (HRs), and odds ratios (ORs) were calculated using fixed or random-effects models. Subgroup analyses and publication bias assessment were conducted.ResultsTwenty-two studies comprising over 13 million births were included. Unadjusted analyses showed no association between CS and IBD (RR: 0.98, 95% CI: 0.88–1.08), CD (RR: 0.99, 95% CI: 0.88–1.12), however, an inverse association was observed for UC (RR: 0.82, 95% CI: 0.72–0.95). Regional variation was observed, with CS associated with reduced IBD risk in Denmark, Switzerland, and Norway, but increased risk in Germany and Australia. Adjusted analyses consistently demonstrated no association: IBD (HR: 1.14, 95% CI: 0.99–1.30; OR: 0.91, 95% CI: 0.65–1.25), CD (HR: 1.07, 95% CI: 0.90–1.28; OR: 1.11, 95% CI: 0.98–1.26), and UC (HR: 0.96, 95% CI: 0.87–1.05; OR: 1.05, 95% CI: 0.86–1.27). No publication bias was detected.ConclusionAcross over 13 million births, delivery mode was not associated with IBD, CD, or UC risk. Despite biologically plausible mechanisms linking CS to altered microbiome patterns, epidemiological evidence does not support CS as an independent IBD risk factor. These findings provide reassurance for clinical counseling regarding CS and long-term IBD risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251237413, PROSPERO CRD420251237413.
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