Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks

Tejada, Begoña Martínez de

doi:10.3390/ijerph110807993

Cited by 101 publications

(55 citation statements)

References 114 publications

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“…Because women who deliver for maternal or fetal indications are less likely to receive antibiotics than women who deliver for spontaneous indications, 75 it is possible that the variable for receipt of antibiotics conveys information about spontaneous preterm deliveries, which were at reduced risk of ASD without ID. Thus, the receipt of antibiotics may merely be an indicator or correlate of reduced risk that is not involved in lowering risk.…”

Section: Discussionmentioning

confidence: 99%

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

Joseph¹,

Korzeniewski²,

Allred³

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND No prospective cohort study of high-risk children has used rigorous exposure assessment and optimal diagnostic procedures to examine the perinatal antecedents of autism spectrum disorder (ASD), separately among those with and without cognitive impairment. OBJECTIVE To identify perinatal factors associated with increased risk for ASD with and without intellectual disability (ID: IQ < 70) in children born extremely preterm. STUDY DESIGN This prospective multi-center (14 institutions in 5 states) birth cohort study included children born at 23-27 weeks gestation in 2002-2004 who were evaluated for ASD and ID at age 10 years. Pregnancy information was obtained from medical records and by structured maternal interview. Cervical-vaginal ‘infection’ refers to maternal report of bacterial infection (n = 4), bacterial vaginosis (n = 30), yeast infection (n = 62), mixed infection (n = 4) or other/unspecified infection (n=43; e.g., chlamydia, trichomonas or herpes, etc.). We do not know the extent to which ‘infection’ per se was confirmed by microbial colonization. We use the terms ‘fetal growth restriction’ and ‘small for gestational age’ interchangeably in light of the ongoing challenge to discern pathologically from constitutionally small newborns. Severe fetal growth-restriction was defined as a birth weight Z-score for gestational age at delivery < - 2 (i.e., 2 standard deviations or more below the median birth weight in a referent sample that excluded pregnancies delivered for preeclampsia or fetal indications). Participants were classified into four groups based on whether or not they met rigorous diagnostic criteria for ASD and ID (ASD+/ID−, ASD+/ID+, ASD−/ID+ and ASD−/ID−). Temporally-ordered multinomial logistic regression models were used to examine the information conveyed by perinatal factors about increased risk for ASD and/or ID (ASD+/ID−, ASD+/ID+ and ASD−/ID+). RESULTS 889 of 966 (92%) children recruited were assessed at age 10 years, of whom 857 (96%) were assessed for ASD; of these, 840 (98%) children were assessed for ID. ASD+/ID− was diagnosed in 3.2% (27/840), ASD+/ID+ in 3.8% (32/840), and ASD−/ID+ in 8.5% (71/840). Maternal report of presumed cervical-vaginal ‘infection’ during pregnancy was associated with increased risk of ASD+/ID+ (odd ratio [OR], 2.7; 95% CI, 1.2-6.4). The lowest gestational age category (23-24 weeks) was associated with increased risk of ASD+/ID+ (OR, 2.9; 95% CI, 1.3-6.6) and ASD+/ID− (OR, 4.4; 95% CI, 1.7-11). Severe fetal growth restriction was strongly associated with increased risk for ASD+/ID− (OR, 9.9; 95% CI, 3.3-30), whereas peripartum maternal fever was uniquely associated with increased risk of ASD−/ID+ (OR, 2.9; 95% CI, 1.2-6.7). CONCLUSION Our study confirms that low gestational age is associated with increased risk for ASD irrespective of intellectual ability, whereas severe fetal growth restriction is strongly associated with ASD without ID. Maternal report of cervical-vaginal infection is associated with increased risk of ASD with ID, and per...

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Section: Discussionmentioning

confidence: 99%

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

Joseph¹,

Korzeniewski²,

Allred³

et al. 2017

American Journal of Obstetrics and Gynecology

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show abstract

“…4,5 The Centers for Disease Control estimates that 20% of pregnant women are exposed to antibiotics before delivery, while 50% are exposed during the processes of labour and delivery in accordance with protocols for caesarean section, intrapartum antibiotic prophylaxis against Group B streptococcus (GBS) colonisation and suspected intrauterine infection/chorioamnionitis. 6 …”

Section: Introductionmentioning

confidence: 99%

Specific class of intrapartum antibiotics relates to maturation of the infant gut microbiota: a prospective cohort study

Coker

Hoen

Dade

et al. 2019

BJOG

100

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Objective To evaluate the potential impact of intrapartum antibiotics, and their specific classes, on the infant gut microbiota in the first year of life. Design Prospective study of infants in the New Hampshire Birth Cohort Study (NHBCS). Settings Rural New Hampshire, USA. Population or sample Two hundred and sixty-six full-term infants from the NHBCS. Methods Intrapartum antibiotic use during labour and delivery was abstracted from medical records. Faecal samples collected at 6 weeks and 1 year of age were characterised by 16S rRNA sequencing, and metagenomics analysis in a subset of samples. Exposures Maternal exposure to antibiotics during labour and delivery. Main outcome measure Taxonomic and functional profiles of faecal samples. Results Infant exposure to intrapartum antibiotics, particularly to two or more antibiotic classes, was independently associated with lower microbial diversity scores as well as a unique bacterial community at 6 weeks (GUnifrac, P = 0.02). At 1 year, infants in the penicillin-only group had significantly lower α diversity scores than infants not exposed to intrapartum antibiotics. Within the first year of life, intrapartum exposure to penicillins was related to a significantly lower increase in several taxa including Bacteroides, use of cephalosporins was associated with a significantly lower rise over time in Bifidobacterium and infants in the multi-class group experienced a significantly higher increase in Veillonella dispar. Conclusions Our findings suggest that intrapartum antibiotics alter the developmental trajectory of the infant gut microbiome, and specific antibiotic types may impact community composition, diversity and keystone immune training taxa.

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“…Many prenatal factors, such as cesarean delivery, prenatal stress, and antibiotic use, might influence the development of childhood wheeze/asthma . Most pregnant women are exposed to some types of medication during pregnancy . Specifically, antibiotics are among the frequently prescribed medication during pregnancy .…”

mentioning

confidence: 99%

Prenatal antibiotic use and risk of childhood wheeze/asthma: A meta‐analysis

Zhao

Cheng

et al. 2015

Pediatric Allergy Immunology

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This meta-analysis suggests that antibiotic exposure during pregnancy may increase the risk of wheeze/asthma in childhood. Besides, the risk of developing wheeze/asthma in childhood was marked during last two trimesters of pregnancy. Future studies of large-size and prospective cohorts which adequately address concerns for confounder bias are needed to examine the relationship between antibiotic use and risk of childhood asthma.

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Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks

Cited by 101 publications

References 114 publications

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks’ gestation

Specific class of intrapartum antibiotics relates to maturation of the infant gut microbiota: a prospective cohort study

Prenatal antibiotic use and risk of childhood wheeze/asthma: A meta‐analysis

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