A systematic review and meta-analysis shows that maternal antibiotic use during pregnancy may increase the risk of children born with pediatric asthma and other atopy-related diseases.Lead study author Lisa Cait, Ph.D., and colleagues note that antibiotic use during pregnancy is significantly associated with the development of childhood asthma . In addition, prenatal antibiotic exposure has been associated with atopic diseases, including atopic sensitization, dermatitis/eczema,food allergy,allergic rhinitis, and wheezing. Antibiotics account for 80% of prescription drugs during pregnancy, and it is estimated that 20%-25% of pregnant women will receive at least one course of antibiotics during pregnancy.
From the 6060 citations retrieved, 11 prospective studies and 16 retrospective studies met the selection criteria. For each study, they assessed risk of bias using the Newcastle-Ottawa Quality Assessment Scale and rated the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
included studies published between 2002 and 2020 and conducted in Europe, North America, Asia, and South America. The findings came from unsupervised questionnaires, interviews with medical professionals or from official medical databases, and studies assessed antibiotic exposure before birth or during pregnancy.
Main results
Antibiotic use during pregnancy was associated with an increased relative risk of developing wheeze (RR, 1.51; 95% CI, 1.17 to 1.94) or asthma (RR, 1.28; 95% CI, 1.22 to 1.34) in childhood.
Antibiotic use during pregnancy also increased the risk of children developing eczema or dermatitis (RR, 1.28; 95% CI, 1.06 to 1.53) and allergic rhinitis (RR, 1.13; 95% CI, 1.02 to 1.25).
The risk of food allergy was also increased in one study (RR, 1.81; 95% CI, 1.11 to 2.95).
Significance of the study
The findings are critical for antibiotic stewardship throughout pregnancy, the authors noted. However, the quality of the evidence in this study was low due to high heterogeneity and population size issues across studies. Other limitations mainly include the study involving only white and European populations and inconsistent research protocols.
The authors note that while there is evidence that antibiotic treatment during pregnancy is a driver of atopy, more research is needed to draw further firm conclusions due to considerable heterogeneity between studies. Future research should employ and report more direct and objective measures rather than questionnaire forms.
Dustin D. Flannery, Ph.D., noted that this is a good study and noted that although the study suggests an association, it does not prove causation. The relationship between prenatal antibiotic treatment and allergic disease in children is multifactorial and complex.
Dustin D. Flannery, Ph.D., suggested that further research should be conducted and that more rigorous exploration or research is needed in this area due to differences in how antibiotic exposure and outcomes are defined in studies.
Although there are certain limitations, given that some studies have found that This systematic review and meta-analysis raises an important question regarding the association of pre-antibiotic exposure with atopic and allergic diseases , including asthma , and this finding continues to support that it should be safely reduced during pregnancy Antibiotic use.
References
Janeczko. Antibiotics During Pregnancy May Increase Child's Risk for Asthma and Other Atopic Diseases - Medscape - Jun 23, 2022.
