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Prenatal antibiotic exposure, asthma, and the atopic march: A systematic review and meta-analysis
Alissa Cait1, Alexander Wedel2, Jeanne L Arntz3
1Malaghan Institute of Medical Research, Wellington, New Zealand.
Insights
Prenatal antibiotic exposure is linked to a higher risk of childhood asthma and related allergic conditions like eczema and allergic rhinitis. Further high-quality research is needed to confirm these findings.
Area of Science:
- Pediatric Allergy and Immunology
- Perinatal Medicine
- Epidemiology
Background:
- Antibiotic use during pregnancy is a growing concern regarding potential long-term health effects on offspring.
- The association between prenatal antibiotic exposure and the development of childhood asthma and atopic diseases requires further investigation.
Approach:
- A comprehensive meta-analysis was conducted, systematically searching multiple databases (Medline, Proquest, Embase, Cochrane) for relevant studies.
- Inclusion criteria focused on studies examining prenatal antibiotic use and childhood atopic disease incidence, specifically asthma and wheeze.
- Study quality and evidence certainty were assessed using the Newcastle-Ottawa Scale and GRADE approach, respectively.
Key Points:
- Maternal antibiotic use during pregnancy was associated with an increased relative risk (RR) for childhood wheeze (RR 1.51) and asthma (RR 1.28).
- The risk for other atopic march conditions, including eczema/dermatitis (RR 1.28) and allergic rhinitis (RR 1.13), was also elevated.
- One study indicated an increased risk for food allergy (RR 1.81) associated with prenatal antibiotic exposure.
Conclusions:
- Prenatal antibiotic exposure is linked to an increased risk of wheeze, asthma, and other atopic diseases in children.
- High heterogeneity in the data and low certainty of evidence underscore the need for more rigorous, high-quality research.
- These findings emphasize the importance of judicious antibiotic stewardship during pregnancy.
Abstract:
Antibiotic use during pregnancy may increase the risk for asthma in children. We performed a meta-analysis assessing prenatal antibiotic exposure and the risk for childhood wheeze or asthma, as well as for diseases associated with the atopic march. A systematic literature search protocol (PROSPERO-ID: CRD42020191940) was registered and searches were completed using Medline, Proquest, Embase, and the Cochrane central register of controlled trials. Screening for inclusion criteria: published in English, German, French, Dutch, or Arabic, intervention (use of any antibiotic at any time point during pregnancy), and disease (reporting atopic disease incidence in children with a primary outcome of asthma or wheeze), and exclusion criteria: reviews, preclinical data, and descriptive studies, yielded 27 studies. Study quality was assessed using the Newcastle-Ottawa Assessment Scale. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Our meta-analysis demonstrates that antibiotic use during pregnancy is associated with an increased relative risk (RR) of developing wheeze RR 1.51 (95% CI: 1.17-1.94) or asthma RR 1.28 (95% CI 1.22-1.34) during childhood. Assessment of the atopic march in association with asthma or wheeze revealed that antibiotic use during pregnancy also increases the risk for eczema/dermatitis RR 1.28 (95% CI: 1.06-1.53) and allergic rhinitis RR 1.13 (95% CI: 1.02-1.25). One study found an increase in food allergy RR 1.81 (95% CI: 1.11-2.95). Maternal antibiotic use during pregnancy is associated with an increased risk for wheeze or asthma development in children, as well as for diseases involved in the atopic march. There was high heterogeneity in the data, and the certainty of the evidence was determined to be low quality, highlighting the need for more high-quality studies on this topic. These results have importance for antibiotic stewardship throughout the prenatal period. This work was supported by the Deutsche Forschungsgemeinschaft and the Konrad Adenauer Foundation.
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