Intrapartum Antibiotic Exposure and Body Mass Index in Children

Abstract

Background Intrapartum antibiotic prophylaxis (IAP) reduce a newborn’s risk of group B streptococcal infection (GBS) but may lead to an increased childhood body mass index (BMI). Methods Retrospective cohort study of infants (n=223,431) born 2007-2015 in an integrated healthcare system. For vaginal delivery, we compared children exposed to GBS-IAP and to any other type or duration of intrapartum antibiotics to no antibiotic exposure. For Cesarean delivery, we compared children exposed to GBS-IAP to those exposed to all other intrapartum antibiotics, including surgical prophylaxis. BMI over 5 years was compared using non-linear multivariate models with B-spline functions, stratified by delivery mode and adjusted for demographics, maternal factors, breastfeeding and childhood antibiotic exposure. Results In vaginal deliveries, GBS-IAP was associated with higher BMI from 0.5 to 5.0 years of age compared to no antibiotics (P<0.0001 for all time points, Δ BMI at age 5 years 0.12 kg/m 2, 95% CI 0.07 to 0.16 kg/m 2). Other antibiotics were associated with higher BMI from 0.3 to 5.0 years of age. In Cesarean deliveries, GBS-IAP was associated with increased BMI from 0.7 years to 5.0 years of age (P<0.05 for 0.7-0.8 years, P<0.0001 for all other time points) compared to other antibiotics (Δ BMI at age 5 years 0.24 kg/m 2, 95% CI 0.14 to 0.34 kg/m 2). Breastfeeding did not modify these associations. Conclusion GBS-IAP was associated with a small but sustained increase in BMI starting at very early age. This association highlights the need to better understand the effects of perinatal antibiotic exposure on childhood health.

Higher body mass index after intrapartum antibiotic exposure in children persists over 10‐years

“…IAP reduces a newborn's risk of GBS infection but is also associated with a small but enduring increase in body mass starting at a very early age. 5,6 The population implications of an association between IAP and a child's body weight may be substantial given the exposure prevalence among pregnant women.…”

“…The difference in BMI associated with GBS IAP increased between the ages of 5 and 10 years from 0.09 to 0.14 kg/m 2 in children from vaginal deliveries and from 0.13 to 0.40 kg/m 2 in caesarean deliveries. IAP reduces a newborn's risk of GBS infection but is also associated with a small but enduring increase in body mass starting at a very early age 5,6 . The population implications of an association between IAP and a child's body weight may be substantial given the exposure prevalence among pregnant women.…”

“…We previously reported in two independent studies of body mass index (BMI) trajectories from birth to 5 years of age that maternal IAP administration was associated with a higher BMI starting in infancy 5,6 . For the current analysis, we extended the follow‐up through the age of 10 years to investigate if the observed association persisted.…”

Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative

“…Indiscriminate use of antibiotics can lead to antibiotic resistance 9,10 . There is also concern for long-term consequences of early antibiotic exposure, including the development of obesity later in life [11][12][13] . Antibiotic prescribing practices vary widely among neonatal intensive care units (NICUs), from 2.4% to 97.1% [14][15] .…”

Infant gut microbiota restoration: state of the art

“…According to a recent meta-analysis and a large cohort study, intrapartum antibiotics increase the risk of childhood overweight. 71 , 72 Prolonged exposure to intrapartum antibiotic has also been found to be associated with increased risk of atopic dermatitis. 73 Similarly, repeated use of macrolide antibiotics in early life has been linked to increased BMI and risk of asthma in later childhood.…”