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Early-life antibiotic exposure and type 1 diabetes risk: a systematic review and meta-analysis

Callum De Pasquale1,2, Leonard C Harrison1,2

  • 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.

Frontiers in Endocrinology
|March 2, 2026
PubMed

Insights

Maternal antibiotic use before conception, specifically macrolides, sulfonamides, or tetracyclines, is linked to an increased risk of type 1 diabetes (T1D) in offspring. Other exposure periods showed no significant association.

Area of Science:

  • Immunology
  • Microbiome Research
  • Public Health

Background:

  • Antibiotic exposure can alter the gut microbiome and infant immune development.
  • Early-life antibiotic use has been inconsistently linked to type 1 diabetes (T1D) risk.
  • Understanding this association is crucial for public health and preventative strategies.

Purpose of the Study:

  • To systematically review and meta-analyze the association between early-life antibiotic exposure and T1D development.
  • To investigate specific antibiotic classes and timing of exposure in relation to T1D risk.
  • To identify potential modifiable risk factors for T1D.

Main Methods:

  • Systematic review and meta-analysis of observational studies.
  • Searched Medline, Embase, Web of Science, and Scopus databases.
  • Included 20 studies with 10,960 T1D cases, analyzing data from preconception to 24 months postnatal.

Main Results:

  • Maternal preconception exposure to macrolide, sulfonamide/trimethoprim, or tetracycline antibiotics was associated with increased T1D odds (ORs ranging from 1.23 to 1.34).
  • No significant association was found for prenatal, neonatal, or postnatal antibiotic exposure.
  • Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).

Conclusions:

  • Preconception antibiotic exposure to specific classes may be a modifiable maternal risk factor for offspring T1D.
  • Findings suggest potential implications for antibiotic prescribing guidelines.
  • Further research is needed to validate these associations and explore precise timing of exposure.
Abstract

Keywords:
antibiotic exposureearly lifemeta-analysispre-conceptionsystematic reviewtype 1 diabetes

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