Maternal exposure to antibiotics and risk of atopic dermatitis in childhood: a systematic review and meta-analysis

Abstract

BackgroundAlthough the association between maternal exposure to antibiotics and the risk of atopic dermatitis (AD) in childhood has been studied extensively, there still is a lack of clarity on the topic. The aim of this study was to summarize the published data and to examine if maternal exposure to antibiotics increases the risk of AD in childhood.MethodsSystematic search was performed in PubMed, Scopus, Web of Science, and Embase for all types of studies on the review subject independent of any language restrictions and published up to 28th December 2022. Data was analyzed using random-effects model and presented as pooled odds ratio (OR) with 95% confidence intervals (CI).ResultsA total of 18 studies (5,354,282 mother-child pairs) were included. Maternal exposure to antibiotics was associated with an increased risk of AD in childhood (OR: 1.14, 95% CI: 1.06, 1.22, I2 = 85%, p = 0.0003). The significance of the results was not affected by the location of the study (Asia or Europe). While subgroup analysis based on exposure assessment or diagnosis of AD demonstrated a tendency of increased risk of AD, the association was not statistically significant in multiple subgroups. Segregating data based on the timing of exposure did not affect the significance of the results for studies on all trimesters. However, there was no association between antibiotic exposure in the third trimester or just before delivery and the risk of childhood AD.ConclusionThe results of this meta-analysis suggest that maternal exposure to antibiotics may lead to a modestly increased risk of AD in offspring. The evidence is limited by high interstudy heterogeneity and bias in exposure and outcome assessment. Future studies are needed to explore if the timing of exposure, the dose, the number of prescriptions, and the type of antibiotic affect this association.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023387233.

The skin microbiome in pediatric atopic dermatitis and food allergy

“…There has been some evidence from meta-analyses for the link between antibiotic use in pregnancy (n = 18 studies) 57 and early life (n = 22 studies) 58 and infant AD. These studies varied considerably in design, ranging from cohort studies to case-control studies and retrospective medical record reviews, yielding high heterogeneity.…”

“…Wan et al 57 in particular showed that significant links were demonstrated only for retrospective studies but not for prospective or cross-sectional studies, suggesting that a degree of ascertainment bias may exist. Confounding by indication may also be present in studies where the indication for antibiotic prescriptions may be due to early skin disease or infections.…”

The Role of the Microbiota in the Pathogenesis and Treatment of Atopic Dermatitis—A Literature Review

“…There is a higher likelihood of childhood AD observed in cases where mothers used antibiotics during pregnancy [ 140 ]. In utero exposure to antibiotics, regardless of trimester, has been proven to raise the risk of eczema by 38%, with a more pronounced effect noted in children exposed to penicillin [ 141 , 142 ]. Yamamoto-Hanada et al discovered that the notable connection to eczema was primarily influenced by the use of macrolides [ 143 ].…”

“…Yamamoto-Hanada et al discovered that the notable connection to eczema was primarily influenced by the use of macrolides [ 143 ]. Studies have shown positive associations between exposure to antibiotics and AD, especially within the first year of life [ 136 , 142 , 143 ]. Postnatal antibiotic exposure in infants is also associated with an increased risk (40–80%) of developing atopic eczema [ 122 , 141 ].…”