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Association between prenatal antimicrobial use and offspring attention deficit hyperactivity disorder
Jennifer K Straughen1, Alexandra R Sitarik1, Ganesa Wegienka1
1Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States of America.
Insights
Maternal use of frequent antibiotics or any antifungals during pregnancy was linked to a higher risk of attention deficit hyperactivity disorder (ADHD) in children by age 10.
Area of Science:
- Neurodevelopmental disorders
- Microbiome research
- Environmental health
Background:
- Gut-brain axis plays a role in neurodevelopment.
- Limited research exists on the link between prenatal antimicrobial exposure and attention deficit hyperactivity disorder (ADHD).
Purpose of the Study:
- To investigate the association between maternal use of antimicrobials during pregnancy and ADHD in offspring at 10 years of age.
Main Methods:
- Utilized data from a diverse birth cohort study.
- Extracted maternal antimicrobial use from medical records.
- Assessed ADHD diagnoses via parental report at age 10.
- Employed Poisson regression to calculate risk ratios and evaluated effect modification.
Main Results:
- No overall association between prenatal antibiotic exposure and ADHD.
- Increased ADHD risk observed with 3+ courses of prenatal antibiotics (RR=1.58).
- Prenatal antifungal exposure associated with higher ADHD risk (RR=1.60).
- Prenatal antifungal use showed increased ADHD risk in males (RR=1.82) but not females.
Conclusions:
- Maternal prenatal antifungal use and frequent antibiotic use are associated with increased ADHD risk in offspring.
- Highlights the significance of the prenatal environment in neurodevelopment.
- Underscores the need for judicious antimicrobial use during pregnancy.
Background:
Gut-brain cross-talk may play an important role in modulating neurodevelopment. Few studies have examined the association between antimicrobials that influence infant gut microbiota assemblage and attention deficit hyperactivity disorder (ADHD).
Objective:
To examine the association between maternal prenatal antimicrobial use and ADHD in offspring at 10 years of age.
Methods:
Data are from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study, a racially and socioeconomically diverse birth cohort in metropolitan Detroit, Michigan. Maternal antimicrobial use was extracted from the medical record. ADHD diagnoses were based on parental report at the 10-year study visit. Poisson regression models with robust error variance were used to calculate risk ratios (RR). Cumulative frequency of exposure to antibiotics, and effect modification were also evaluated.
Results:
Among the 555 children included in the analysis, 108 were diagnosed with ADHD. During pregnancy, 54.1% of mothers used antibiotics while 18.7% used antifungals. Overall, there was no evidence of an association between prenatal antibiotic exposure and ADHD (RR [95% CI] = 0.98 [0.75, 1.29]), but there was an increased risk of ADHD among those with mothers using 3+ courses of antibiotics (RR [95%CI] = 1.58 [1.10, 2.29]). Prenatal exposure to antifungals was associated with a 1.6 times higher risk of ADHD (RR [95% CI] = 1.60 [1.19, 2.15]). In examining effect modification by child sex for antifungal use, there was no evidence of an association among females (RR [95% CI] = 0.97 [0.42, 2.23]), but among males, prenatal antifungal use was associated with 1.82 times higher risk of ADHD (RR [95% CI] = 1.82 [1.29, 2.56]).
Conclusions:
Maternal prenatal antifungal use and frequent prenatal antibiotic use are associated with an increased risk of ADHD in offspring at age 10. These findings highlight the importance of the prenatal environment and the need for careful use of antimicrobials.
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