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Oral contraceptives, reproductive factors and risk of inflammatory bowel disease.

ABSTRACT: Oral contraceptive use has been associated with risk of Crohn's disease (CD) and ulcerative colitis (UC).To determine whether this association is confounded or modified by other important lifestyle and reproductive factors.A prospective cohort study was carried out of 117,375 US women enrolled since 1976 in the Nurses Health Study I (NHS I) and 115,077 women enrolled since 1989 in the Nurses' Health Study II (NHS II) with no prior history of UC or CD. These women had provided information every 2 years, on age at menarche, oral contraceptive use, parity, menopause status and other risk factors. Diagnoses of CD and UC were confirmed by review of medical records. Cox proportional hazards models were used to calculate HRs and 95% CIs.Among 232,452 women with over 5,030,196 person-years of follow-up, 315 cases of CD and 392 cases of UC were recorded through 2007 in NHS II and 2008 in NHS I. Compared with never users of oral contraceptives, the multivariate-adjusted HRs for CD were 2.82 (95% CI 1.65 to 4.82) among current users and 1.39 (95% CI 1.05 to 1.85) among past users. The association between oral contraceptives and UC differed according to smoking history (pheterogeneity=0.04). Age at menarche, age at first birth and parity were not associated with risk of UC or CD.In two large prospective cohorts of US women, oral contraceptive use was associated with risk of CD. The association between oral contraceptive use and UC was limited to women with a history of smoking.

SUBMITTER: Khalili H

PROVIDER: S-EPMC3465475 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Oral contraceptives, reproductive factors and risk of inflammatory bowel disease.

Khalili Hamed H Higuchi Leslie M LM Ananthakrishnan Ashwin N AN Richter James M JM Feskanich Diane D Fuchs Charles S CS Chan Andrew T AT

Gut 20120522 8

<h4>Background</h4>Oral contraceptive use has been associated with risk of Crohn's disease (CD) and ulcerative colitis (UC).<h4>Objective</h4>To determine whether this association is confounded or modified by other important lifestyle and reproductive factors.<h4>Design</h4>A prospective cohort study was carried out of 117,375 US women enrolled since 1976 in the Nurses Health Study I (NHS I) and 115,077 women enrolled since 1989 in the Nurses' Health Study II (NHS II) with no prior history of UC ...[more]

PMID: 22619368

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Project description:Background and aimsInflammatory bowel diseases (IBD) are considered to be dysregulated, immune-mediated disorders; and immunosuppressive medications are the mainstay of their treatment. Clinically, we have often observed low serum immunoglobulin (Ig) levels in these patients. The aim of this study was to assess the frequency and risk factors of secondary humoral immunodeficiency in IBD patients.MethodsWe conducted a cross-sectional study of eligible IBD patients with Crohn's disease (CD), ulcerative colitis (UC), indeterminate colitis (IC) or restorative proctocolectomy with ileal pouch, who having serum Ig measured. Demographic and clinical variables were measured. Univariate and multivariate analyses were performed.ResultsA total of 324 patients was included, with a mean age of 38.8 years and 158 (48.8%) being male. Low IgG, IgG1, IgA, and IgM were found in 22.7%, 23.4%, 7.9%, and 10.9% of patients, respectively. The shared risk factors for a low IgG or IgM level were increasing age [odds ratio (OR)?=?1.13; 95% confidence interval (CI) 1.03-1.23 for low IgG level and OR?=?1.33; 95% CI 1.15-1.56 for low IgM level] and hypoalbuminemia (OR?=?1.83; 95% CI 1.01-3.33 for low IgG level and OR?=?3.17; 95% CI 1.23-8.15 for low IgM level). In addition, thioprine use was associated with low IgA level (OR?=?2.76; 95% CI 1.03-7.39). IBD disease duration was a risk factor for low IgG1 level (OR?=?1.40; 95% CI 1.12-1.76). The presence of concurrent primary sclerosing cholangitis (OR?=?0.064; 95% CI 0.007-0.60) and the use of biologics (OR?=?0.16; 95% CI 0.033-0.79) were associated with normal IgG1 level. IgG level was lower in CD patients than that in UC/IC and ileal pouch patients (P?=?0.042). IgG and IgA levels were elevated in patients with inflammatory conditions of the pouch (P?=?0.01; P?=?0.003, respectively).ConclusionsLow Ig level appears to be common in IBD patients. Increasing age, disease duration and hypoalbuminemia appeared to be risk factors. The findings may provide rationale for targeted therapy to boost humoral immunity in selected patients with IBD.

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Oral contraceptives, reproductive factors and risk of inflammatory bowel disease.

Publications

Oral contraceptives, reproductive factors and risk of inflammatory bowel disease.

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