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Published on: August 7, 2017
Dose, Timing, and Spectrum of Prenatal Antibiotic Exposure and Risk of Childhood Asthma
Kedir N Turi1, Tebeb Gebretsadik2, Tan Ding2
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Prenatal antibiotic exposure, especially early or broad-spectrum use, increases childhood asthma risk. Judicious antibiotic selection and timing during pregnancy are key to prevention.
Area of Science:
- Perinatal Medicine
- Pediatric Allergy
- Pharmacovigilance
Background:
- The link between prenatal antibiotic exposure and childhood asthma risk remains unclear.
- Understanding the impact of antibiotic timing, dose, and spectrum is crucial.
Purpose of the Study:
- To investigate the association between prenatal antibiotic exposure and the risk of developing childhood asthma.
- To determine how timing, dose, and spectrum of exposure influence this risk.
Main Methods:
- A population-based cohort study involving 84,214 mother-child dyads.
- Multivariable logistic regression models were employed to analyze the data.
Main Results:
- Sixty-four percent of pregnant women received antibiotics.
- Increased antibiotic dose, early pregnancy exposure, and broad-spectrum antibiotic use were linked to higher childhood asthma odds.
- Maternal asthma status modified the effects of antibiotic exposure.
Conclusions:
- Cumulative dose, early first course, and broad-spectrum antibiotics are associated with increased childhood asthma risk.
- Judicious prenatal antibiotic use, considering timing and spectrum, may help prevent childhood asthma.
Background:
The potential for prenatal antibiotic exposure to influence asthma risk is not clear. We aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma.
Methods:
We conducted a population-based cohort study of 84 214 mother-child dyads to examine the association of prenatal antibiotic exposure and childhood asthma using multivariable logistic regression models.
Results:
Sixty-four percent of pregnant women received antibiotics. Prenatal antibiotic exposure was associated dose-dependently with increased odds of childhood asthma (adjusted odds ratio [aOR] for interquartile increase of 2 courses [interquartile range, 0-2], 1.26 [95% confidence interval {CI}, 1.20-1.33]). Among children exposed to at least 1 course in utero, the effect of timing at the first course was moderated by total maternal courses. Among pregnant women receiving a single antibiotic course, timing of exposure had no effect on childhood asthma risk. Among women receiving > 1 course, early exposure of the first course was associated with greater childhood asthma risk. Compared to narrow spectrum-only antibiotic use, broad spectrum-only antibiotic exposure was associated with increased odds of asthma (aOR, 1.14 [95% CI, 1.05-1.24]). There were effect modifications (P < .001) by maternal asthma on total courses, and on timing of the first course, significant only among those without maternal asthma.
Conclusions:
Increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk. Our study provides important evidence supporting judicious prenatal antibiotic use, particularly timing of use and choice of antibiotics, in preventing subsequent childhood asthma.
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