Abstract
SummaryBackgroundHow contraceptive formulation, dose, duration of therapy and mode of delivery affects the risk of inflammatory bowel disease (IBD) is poorly described.AimTo examine associations between types of hormonal contraception and development of IBD.MethodsThis was a nested case-control study using IQVIA Medical Research Data. Women aged 15-49 years with a new diagnosis of IBD were matched with up to six controls by age, practice and year. Odds ratios (OR) and 95% confidence intervals (95% CI) for incident IBD and use of contraception were calculated.Results4932 incident cases of IBD were matched to 29 340 controls. Use of combined oral contraceptive pills (COCPs) was associated with the development of Crohn's disease and ulcerative colitis (OR 1.60 [1.41-1.82] and 1.30 [1.15-1.45], respectively). Each additional month of COCP exposure per year of follow-up increased risk of Crohn's disease by 6.4% (5.1%-7.7%) and ulcerative colitis by 3.3% (2.1%-4.4%). Progestogen-only pills had no effect on Crohn's disease risk (OR 1.09 [0.84-1.40]) but there was a modest association with ulcerative colitis (OR 1.35 [1.12-1.64]). Parenteral contraception was not associated with the development of Crohn's disease or ulcerative colitis (OR 1.15 [0.99-1.47] and 1.17 [0.98-1.39], respectively).ConclusionsWe observed an increase in the risk of IBD with increasing duration of exposure to COCPs. Progestogen-only pills were not associated with Crohn's disease but there was a modest association with ulcerative colitis. There was no association between parenteral progestogen-only contraception and IBD. These findings are broadly consistent with a hypothesis that the oestrogen component of contraception may drive IBD pathogenesis.
Highlights
In the UK, approximately 26% of women of reproductive age use hormonal contraception[2] and combined oral contraceptive pills (COCPs) which work by releasing an oestrogen and a progestogen are the most popular method
Has the diagnosis of inflammatory bowel disease (IBD) been validated in a similar GP database,[22] but we have demonstrated that 98.2% of individuals coded for incident IBD in IQVIA Medical Research Data (IMRD) have a record of at least one additional clinical event supportive of the diagnosis with 87.7% having at least two supporting events.[23]
We found use of all types of contraceptive pills to be associated an increase in risk of UC; Odds ratios (OR) 1.27 for second- generation COCPs, 1.38 for newer generation COCPs and 1.25 for POPs, with risk increasing slightly amongst current users; OR 1.48 for second-generation COCPs, 1.62 for newer generation COCPs and 1.35 for POPs
Summary
To examine associations between types of hormonal contraception and development of IBD. We aimed to examine the association between various types of contraception and development of IBD
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