The Effect of Early-Life Environmental Exposures on Disease Phenotype and Clinical Course of Crohn’s Disease in Children

Livia Lindoso, Kajari Mondal, Suresh Venkateswaran, Hari K. Somineni, Cortney Ballengee, Thomas D. Walters, Anne Griffiths, Joshua D. Noe, Wallace Crandall, Scott Snapper, Shervin Rabizadeh, Joel R. Rosh, Neal LeLeiko, Stephen Guthery, David Mack, Richard Kellermayer, Ajay S. Gulati, Marian D. Pfefferkorn, Dedrick E. Moulton, David KeljoStanley Cohen, Maria Oliva-Hemker, Melvin B. Heyman, Anthony Otley, Susan S. Baker, Jonathan S. Evans, Barbara S. Kirschner, Ashish S. Patel, David Ziring, Michael C. Stephens, Robert Baldassano, Marla C. Dubinsky, James Markowitz, Lee A. Denson, Jeffrey Hyams, Subra Kugathasan, Ashwin N. Ananthakrishnan

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objectives: Environmental factors play an important role in the pathogenesis of Crohn’s Disease (CD). In particular, by virtue of the instability of the microbiome and development of immunologic tolerance, early life factors may exert the strongest influence on disease risk and phenotype. Methods: We used data from 1119 CD subjects recruited from RISK inception cohort to examine the impact of early life environment on disease progression. Our primary exposures of interest were breastfeeding in infancy and exposure to maternal, active, or passive smoke. Our primary outcomes were development of complicated (stricturing or penetrating) disease, and need for CD-related hospitalization, and surgery. Multivariable logistic regression models were used to define independent associations, adjusting for relevant covariates. Results: Our study cohort included 1119 patients with CD among whom 15% had stricturing (B2) or penetrating disease (B3) by 3 years. 331 patients (35%) and 95 patients (10.6%) required CD-related hospitalizations and surgery respectively. 74.5% were breastfed in infancy and 31% were exposed to smoking among whom 7% were exposed to maternal smoke. On multivariable analysis, a history of breastfeeding was inversely associated with complicated (B2/B3 disease) 0.65, CI 95% 0.44–96; P = 0.03) in pediatric CD. Maternal smoking during pregnancy was associated with increased risk of hospitalization during the 3-year follow-up period (OR 1.75, CI 95% 1.05–2.89; P = 0.03). Conclusions: Early life environmental factors influence the eventual phenotypes and disease course in CD.

Original languageEnglish (US)
Pages (from-to)1524-1529
Number of pages6
JournalAmerican Journal of Gastroenterology
Issue number10
StatePublished - Oct 1 2018

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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