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Association between early life (prenatal and postnatal) antibiotic administration and coeliac disease: a systematic
Maciej Kołodziej1, Bernadeta Patro-Gołąb1, Dorota Gieruszczak-Białek1
1Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Insights
Early life antibiotic exposure, both before and after birth, does not appear to increase the risk of developing coeliac disease (CD). This systematic review found no conclusive evidence linking antibiotic use in infancy to CD development.
Area of Science:
- Gastroenterology
- Pediatrics
- Epidemiology
Background:
- Antibiotic use during early life is common.
- The potential impact of antibiotic exposure on the development of coeliac disease (CD) and CD autoimmunity remains unclear.
- Understanding this association is crucial for public health guidance.
Purpose of the Study:
- To systematically review observational studies investigating the association between prenatal and/or postnatal antibiotic exposure and the risk of coeliac disease (CD) or CD autoimmunity.
- To synthesize current evidence regarding the link between early antibiotic use and CD development.
Main Methods:
- A systematic review of observational studies (cohort, cross-sectional, case-control) was conducted.
- Studies were identified through searches of PubMed and Embase databases up to December 2018.
- Inclusion criteria focused on studies assessing antibiotic exposure in early life and subsequent CD or CD autoimmunity diagnosis.
Main Results:
- Six studies met the inclusion criteria.
- Two large cohort studies found no association between prenatal antibiotic exposure and CD risk.
- Studies on postnatal antibiotic exposure yielded contradictory results, with one Italian cohort showing a significant positive association, while another large study found no link with CD autoimmunity.
Conclusions:
- Current evidence does not support a link between prenatal antibiotic exposure and an increased risk of coeliac disease.
- The association between postnatal antibiotic exposure and coeliac disease risk is not definitively established, with conflicting findings across studies.
- Further research may be needed to clarify the complex relationship between early antibiotic exposure and immune-mediated conditions like CD.
Objective:
Whether prenatal or postnatal exposure to antibiotics is associated with an increased risk of coeliac disease (CD) is unclear. We systematically reviewed studies on the association between early life antibiotic exposure and the risk of CD or CD autoimmunity.
Design:
Systematic review of observational studies.
Data Sources:
The PubMed and Embase databases were searched up to December 2018, with no language restrictions. Additional references were obtained from reviewed articles.
Eligibility Criteria For Selecting Studies:
Cohort, cross-sectional and case-control studies that assessed the association between prenatal and/or postnatal antibiotic exposure and the odds of developing CD (as defined by authors of the original studies) or CD autoimmunity were eligible for inclusion.
Results:
Six studies were included. In two large cohort studies that focused on prenatal antibiotic exposure, no association with the risk of CD was found (adjusted OR=1.16; 95% CI 0.94 to 1.43 and adjusted HR=1.33; 95% CI 0.69 to 2.56) in the Norwegian and Swedish cohorts, respectively. In three studies that evaluated the association of postnatal antibiotic exposure with the risk of CD, the results were contradictory, with only the Italian cohort study reporting a significant positive association (adjusted incidence rate ratio=1.24; 95% CI 1.07 to 1.43). A large, multicentre cohort study that evaluated the association between postnatal antibiotic exposure and CD autoimmunity in human leukocyte antigen (HLA)-positive subjects found no association.
Conclusions:
We found no evidence of an association between prenatal or postnatal antibiotic exposure and CD.
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