Abstract Background A key question remains unanswered: whether maternal consumption of fish and fish oil supplements during pregnancy is associated with the risk of early childhood inflammatory bowel disease (IBD) in offspring. This association was examined in the present study. Methods Data from the Danish National Birth Cohort (1996–2002) were used, which collected maternal dietary data in early pregnancy using a food frequency questionnaire (FFQ), and data from the National Patient Registry to identify IBD cases. The study included mother-child dyads in which the mother had a singleton pregnancy, responded to the FFQ and demonstrated plausible energy intake and children under the age of 18 were considered. The exposure variables were assessed as tertiles of maternal intake of total fish (g/day), oily fish (g/day), lean fish (g/day), n-3 polyunsaturated fatty acids (PUFA) (g/day) from diet, and fish oil supplements (yes/no). Cox regression was used to calculate the hazard ratio (HR) with 95% confidence intervals (CIs) with the first tertile [T (lower intakes)] as the reference. Analyses were adjusted for maternal educational level, gestational weight gain, alcohol intake, smoking, antibiotics, parental IBD, diet quality (Healthy Eating Index), and offspring antibiotic consumption. Results The study included data on 67,770 mother-child dyads, and, among the offspring, 192 cases of IBD [Crohn disease (CD), n= 106; ulcerative colitis (UC), n= 86] were identified. The mean intake (standard deviation [SD]) in g/d was 27.2 (±6.10) of fish, 14.7 (±3.79) of oily fish and 12.5 (±3.34) of lean fish. The mean (SD) intake of n-3 PUFA was 0.509 g/d (±0.40), and 5.9% of women consumed fish oil during pregnancy. High maternal intake (T3) of n-3 PUFA was associated with a 38% reduction in IBD risk (HR: 0.62, 95% CI: 0.38-0.98) in offspring, whereas average intake of oily fish reduced the risk of UC in offspring (p= 0.047). Average (T2) and high intakes of lean fish also reduced the risk of IBD, by 49% (HR: 0.51, 95% CI: 0.33-0.77) and 35% (HR: 0.65, 95% CI: 0.43-0.98), respectively. More specifically, an average intake of lean fish reduced offspring CD risk by 58% (HR: 0.42, 95% CI: 0.23-0.77). No association was found in relation to the other variables. Conclusion The type of fish consumed during pregnancy appeared to influence the risk of developing CD and UC differently. Our large-scale population study suggests that maternal consumption of oily fish is protective against the development of UC in offspring, while maternal consumption of lean fish is protective against development of CD in offspring. Overall, these results favor fish consumption in pregnancy.
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