Antibiotic Exposure in Early Life and Risk of Type 1 Diabetes: A Meta-Analysis

Area of Science:

• Pediatric Endocrinology
• Microbiome Research
• Immunology

Background:

• Early-life antibiotic administration is hypothesized to increase type 1 diabetes (T1D) risk.
• This risk may be mediated by gut microbiota dysbiosis and altered immune system development.
• This meta-analysis investigates the association between early antibiotic exposure and childhood T1D.

Purpose of the Study:

• To evaluate the association between early-life antibiotic use and the risk of developing type 1 diabetes (T1D).
• To assess the impact of prenatal and postnatal antibiotic exposure on T1D risk.
• To explore how antibiotic course number, class, and spectrum influence this association.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, MEDLINE, Scopus, Web of Science) up to June 2025.
• Random effects models were used to calculate pooled effect sizes for prenatal and postnatal antibiotic exposure.
• Subgroup analyses examined variations by antibiotic course, class, and spectrum; study quality was assessed using the Newcastle-Ottawa Scale.

Main Results:

• The meta-analysis included 20 studies with over 1.5 million participants for prenatal and 4 million for postnatal exposure.
• Postnatal antibiotic exposure showed a pooled effect size of 1.07 (95% CI 1.01-1.14), with increased risk correlating with more courses and broad-spectrum agents.
• Prenatal exposure yielded a pooled effect size of 1.05 (95% CI 0.98-1.11); associations were stronger for broad-spectrum antibiotics.

Conclusions:

• Early-life antibiotic use, particularly repeated and broad-spectrum courses, is associated with an increased risk of T1D.
• Study design variability and potential confounding factors necessitate cautious interpretation.
• Further high-quality prospective studies are essential to establish causality and clarify the role of antibiotics versus underlying infections.