Intrapartum Antibiotics and Childhood Atopic Dermatitis

Abstract

Introduction Atopic dermatitis (AD) in children significantly impacts families due to medical costs, “lost” hours, and secondary characteristics like asthma and ancillary infections. We investigate whether children delivered vaginally to women receiving intrapartum antibiotics have a greater risk of AD under the age of 2 years than their counterparts. Methods We conducted a retrospective analysis of women who delivered child(ren) vaginally between 1996 and 2008. Women were identified as those who received intrapartum antibiotics and those who did not. Pediatric records were used to determine incidence of AD. Results We collected data for 492 mother-child pairs. Intrapartum antibiotics were administered during 128 births; 28.9% of those children were diagnosed with AD by 2 years (RR 1.03 [0.75-1.41], p=0.854). Factors with greatest risks of diagnosis with AD by 2 years were intrapartum antibiotic exposure for >24hrs (RR 1.99 [1.13-3.49], p=0.0173), first born (RR 1.78 [1.33-2.38], p<0.0001) and higher maternal education (RR 1.43[0.99-2.06], p=0.039). No statistical difference in prevalence of AD related to parental eczema, maternal Group B Streptococcus status, or gestational age existed. Conclusions Exposure to antibiotics for <24hrs during a vaginal delivery does not increase the risk of AD. Studies are needed to understand if exposures >24hrs during the intrapartum period increase the risk of AD.

Universal antenatal screening for group B streptococcus may cause more harm than good

“…Other reported harms include neonatal respiratory distress,71 maternal thrush,72 and childhood atopic dermatitis 73. Antibiotic prophylaxis in labour may also limit birth choices for women and contribute to the medicalisation of labour 4.…”

Prenatal antibiotics and atopic dermatitis among 18‐month‐old children in the Danish National Birth Cohort

“…9,10 Filaggrin mutation is generally present among approximately 50% of patients with atopic dermatitis compared to 10% in the general population, and cases with filaggrin mutations tend to have an earlier onset. [12][13][14][15][16][17] However, evidence for a role of prenatal antibiotic exposure is scarce, inconsistent and does not take timing of exposure into account. 11 Maternal use of antibiotics in pregnancy influences the maternal microbiome and hence the very early colonization of the child's own microbiome during pregnancy, birth and breast-feeding in early life.…”

“…2 Perinatal and post-natal exposure to antibiotics has almost consistently been associated with an increased risk of atopic dermatitis in both human and murine models. [12][13][14][15][16][17] However, evidence for a role of prenatal antibiotic exposure is scarce, inconsistent and does not take timing of exposure into account. 10,[18][19][20][21] Four studies found an increased risk of atopic dermatitis among children exposed to prenatal antibiotics, and one study found no association.…”

Breastfeeding and perinatal exposure, and the risk of asthma and allergies

“…However, the evidence linking antibiotic use in pregnancy and childhood with allergic disease in humans is inconclusive [46]. Studies assessing antibiotic use during pregnancy have had inconsistent findings with both increased risk of asthma [47,48] and no increased risk found [49,50]. The association between pet ownership and allergic disease remains unclear.…”