Prenatal antibiotic exposure, asthma, and the atopic march: A systematic review and meta‐analysis

Cait, Alissa; Wedel, Alexander; Arntz, Jeanne L.; Duinkerken, Jacyra; Datye, Swarali; Cait, Jessica; Alhasan, Moumen M.; Conrad, Melanie L.

doi:10.1111/all.15404

Cited by 30 publications

(18 citation statements)

References 70 publications

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“…Finally, we were not able to analyze the effect of prenatal antibiotics on AD by types of antibiotic use, which may have influenced the risk in patients with asthma. 10,11 However, to our knowledge, this effect did not exist when investigating the influence of antibiotic exposure during pregnancy on offspring AD. 9,20,24,33 In conclusion, this cohort study revealed that maternal antibiotic use during pregnancy was associated with a slightly increased risk of childhood AD.…”

Section: Strengths and Limitationsmentioning

confidence: 75%

Prenatal antibiotic exposure and the risk of atopic dermatitis in children: a nationwide population-based cohort study.

Chang

et al. 2022

Preprint

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Background: Atopic dermatitis (AD) contributes to substantial social and financial costs in public health care systems. Antibiotic exposure during pregnancy has been proposed as a risk factor, but findings remain inconsistent. The aim of this study was to investigate the association between prenatal antibiotic use and childhood AD. Methods: We performed a population-based cohort study using data collected from the Taiwan Maternal and Child Health Database from 2009 to 2016. Associations were determined using Cox proportional hazards model and were adjusted for several potential covariates, including maternal atopic disorders and gestational infections. Subgroup analyses evaluated the influence of postnatal infant antibiotic/acetaminophen use on the association between prenatal antibiotic exposure and childhood AD diagnosed after 1 year of age. Results: A total of 1288343 mother-child pairs were identified and 39.5% received antibiotics prenatally. Maternal antibiotic use during pregnancy was slightly positively associated with childhood AD (aHR 1.05, 95% CI 1.04-1.06), especially in the first and second trimesters. An apparent dose-response pattern was observed with an 11% increased risk when the exposure was ≥5 courses prenatally (aHR 1.11, 95% CI 1.09-1.14). Subgroup analysis showed the positive association remained significant regardless of postnatal antibiotic use; however, a negative association was found in children without postnatal infant acetaminophen use (aHR 1.02, 95% CI 0.97-1.07). Conclusion: Maternal antibiotic use during pregnancy was associated with increased risk of childhood AD in a dose-related manner. Possible confounders existed between prenatal antibiotics and postnatal infant acetaminophen use in the subgroup analysis. Further research may be warranted to investigate this variable using a prospectively designed study, and also to examine whether or not this association is specifically related to pregnancy.

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Section: Strengths and Limitationsmentioning

confidence: 75%

Prenatal antibiotic exposure and the risk of atopic dermatitis in children: a nationwide population-based cohort study.

Chang

et al. 2022

Preprint

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“…A meta-analysis [ 12 ] also showed that early respiratory tract infection within 2 years old was associated with the development of asthma in school-age children. It has been demonstrated in numerous studies that maternal adverse exposure during pregnancy, such as passive smoking [ 39 ], diet [ 40 ], psychological status [ 41 ], pregnancy complications [ 42 ], and antibiotic exposure during pregnancy [ 43 ], was associated with a greater likelihood of AR in offspring. Additionally, studies have provided compelling evidence that adverse exposures in the early postnatal period, such as antibiotic use [ 13 ], pet exposure [ 44 ] and air pollution [ 45 ], may increase the risk of a child developing allergies.…”

Section: Discussionmentioning

confidence: 99%

Early exposure to infections increases the risk of allergic rhinitis—a systematic review and meta-analysis

et al. 2023

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Objective The purpose of this study was to provide evidence for early life care by meta-analyzing the relationship between infection during pregnancy and up to 2 years of age and the risk of subsequent allergic rhinitis (AR). Methods Published studies up to April 2022 were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang Database, and VIP. Literature screening, including quality assessment, was performed, and the effect values (OR, HR, RR) and 95% confidence intervals (95% CI) of infection during pregnancy and up to 2 years of age and allergic rhinitis were extracted from each qualified study. Results In total, 5 studies with a sample size of 82,256 reported the relationship between infection during pregnancy and offspring AR. Meta-analysis showed that maternal infection during pregnancy was associated with an increased risk of childhood AR in offspring (OR = 1.34, 95% CI: 1.08–1.67). Altogether, 13 studies with a sample size of 78,426 reported evidence of an association between infection within 2 years of age and subsequent AR in children. A pooled meta-analysis of all studies showed that early infection within 2 years of age was closely associated with childhood AR (OR = 1.25, 95% CI: 1.12–1.40), especially upper respiratory tract infection (OR = 1.32, 95% CI: 1.06–1.65) and gastrointestinal infections (OR = 1.37, 95% CI: 1.01–1.86), but ear infection showed similar results in the cohort study (OR = 1.13, 95% CI: 1.04–1.22). Conclusion Current evidence suggests that infection during pregnancy, early upper respiratory infection, gastrointestinal infections and ear infection within 2 years of age would increase the risk of AR in children. Therefore, the prevention of infection during pregnancy and in infancy and young children needs to be emphasized.

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“…8 Three subsequent meta-analysis showed a positive association. [9][10][11] In a study by Cait et al, the risk of eczema/dermatitis was increased in their pooled data (RR 1.28; 95% CI: 1.06-1.53). However, high heterogeneity among the data was also mentioned by the authors.…”

Section: Introductionmentioning

confidence: 92%

“…The pooled odds ratio (OR), which was 1.3 (95% CI: 0.86–1.95), indicated there was no association, although the estimate was elevated 8 . Three subsequent meta‐analysis showed a positive association 9–11 . In a study by Cait et al, the risk of eczema/dermatitis was increased in their pooled data (RR 1.28; 95% CI: 1.06–1.53).…”

Section: Introductionmentioning

confidence: 99%

Prenatal and early‐life antibiotic exposure and the risk of atopic dermatitis in children: A nationwide population‐based cohort study

Chang

et al. 2023

Pediatric Allergy Immunology

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Background: Atopic dermatitis (AD) contributes to substantial social and financial costs in public health care systems. Antibiotic exposure during pregnancy has been proposed as a risk factor, but findings remain inconsistent. The aim of this study was to investigate the association between prenatal antibiotic use and childhood AD. Methods:We performed a population-based cohort study using data collected from the Taiwan Maternal and Child Health Database from 2009 to 2016. Associations were determined using Cox proportional hazards model and were adjusted for several potential covariates, including maternal atopic disorders and gestational infections.Children with and without maternal predispositions of atopic diseases and postnatal antibiotic/acetaminophen exposures within 1 year were stratified to identify the subgroups at risk. Results:A total of 1,288,343 mother-child pairs were identified and 39.5% received antibiotics prenatally. Maternal antibiotic use during pregnancy was slightly positively associated with childhood AD (aHR 1.04, 95% CI 1.03-1.05), especially in the first and second trimesters. An apparent dose-response pattern was observed with an 8% increased risk when the exposure was ≥5 courses prenatally (aHR 1.08, 95% CI 1.06-1.11). Subgroup analysis showed the positive association remained significant regardless of postnatal infant antibiotic use, but the risk attenuated to null in infants who were not exposed to acetaminophen (aHR 1.01, 95% CI 0.96-1.05). The associations were higher in children whose mothers were without AD compared to those whose mothers were with AD. In addition, postnatal antibiotic or acetaminophen exposure of infants was associated with an increased risk of developing AD after 1 year of age. Conclusion:Maternal antibiotic use during pregnancy was associated with an increased risk of childhood AD in a dose-related manner. Further research may be warranted to investigate this variable using a prospectively designed study, and also to examine whether or not this association is specifically related to pregnancy.

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Prenatal antibiotic exposure, asthma, and the atopic march: A systematic review and meta‐analysis

Cited by 30 publications

References 70 publications

Prenatal antibiotic exposure and the risk of atopic dermatitis in children: a nationwide population-based cohort study.

Prenatal antibiotic exposure and the risk of atopic dermatitis in children: a nationwide population-based cohort study.

Early exposure to infections increases the risk of allergic rhinitis—a systematic review and meta-analysis

Prenatal and early‐life antibiotic exposure and the risk of atopic dermatitis in children: A nationwide population‐based cohort study

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