Trimester-specific association between antibiotics exposure during pregnancy and childhood asthma or wheeze: the role of confounding

Bai, Lianhua; Zhao, Donghui; Cheng, Qiang; Zhang, Yanwu; Wang, Shusi; Zhang, Heng; Xie, Mingyu; He, Rui-Wen; Su, Hong

doi:10.1016/j.annepidem.2018.10.003

Cited by 27 publications

(36 citation statements)

References 43 publications

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“…As for the impact of different stages of pregnancy on childhood asthma/wheeze, a positive correlation between antibiotic exposure during each pregnancy trimester and the risk of childhood asthma/wheeze was observed, and the finding was consistent with a previous meta‐analysis 44 . At the same time, we also noticed that there was a slightly higher risk in the third trimester than in the first or second trimester of pregnancy.…”

Section: Discussionsupporting

confidence: 91%

“…44 At the same time, we also noticed that there was a slightly higher risk in the third trimester than in the first or second trimester of pregnancy. Contrary to our finding, Bai et al 44 reported there was a closer association between the use of antibiotics in the first trimester and the risk of asthma/wheeze in children. In addition, Timm et al 41 revealed that antibiotic use in the Furthermore, antibiotic exposure during pregnancy and allergic diseases in subsequent children were influenced by many maternal characteristics such as maternal age, maternal history of allergy, maternal smoking, delivery mode, and maternal educational level.…”

Section: Discussionmentioning

confidence: 62%

“…Some studies reported that the correlation of antibiotic exposure during pregnancy and allergic disorders in children was significantly positive, while others did not observe any association. Two meta-analyses were found 44,45 ; however, both of them only focused on the association between antibiotic exposure during pregnancy and the risk of childhood asthma/wheeze; several latest pieces of research were missing as well.…”

Section: Introductionmentioning

confidence: 99%

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Maternal antibiotic exposure during pregnancy and the risk of allergic diseases in childhood: A meta‐analysis

Zhong

Zhang

Wang

et al. 2020

Pediatric Allergy Immunology

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Background: Increasing studies suggest that antibiotic exposure during pregnancy may increase the risk of childhood allergic diseases; however, controversy still exists. Thus, we conducted this meta-analysis to evaluate the association between antibiotic use during pregnancy and childhood asthma/wheeze, eczema/atopic dermatitis, and food allergy. Methods: CENTRAL, EMBASE, and PubMed were searched for studies up to July 20, 2020. Cohort studies and case-control studies that estimated the association of antibiotic exposure in pregnancy with the risk of childhood asthma/wheeze, eczema/ atopic dermatitis, and food allergy were included. A random-effects model or fixedeffects model was used to calculate the pooled estimates. The quality of the included studies was assessed by the Newcastle-Ottawa Scale (NOS). Stata12.0 software was used to analyze the association through a meta-analysis. Results: A total of 26 studies were included in the meta-analysis. The results showed that maternal antibiotic exposure in pregnancy and the summary OR for the risk of childhood asthma/wheeze was 1.29 (95% CI = 1.16-1.43), the summary OR for eczema/atopic dermatitis was 1.62 (95% CI = 1.16-2.27), and the pooled OR for food allergy was 1.36 (95% CI = 0.94-1.96). Conclusions: Our results indicated that maternal antibiotic use during pregnancy might increase the risk of asthma/wheeze and eczema/atopic dermatitis but not food allergy in children. Further studies with larger sample size and robust multivariable adjustment are needed to confirm our findings. Nevertheless, the appropriate use of antibiotics during pregnancy is incredibly important, and healthcare professionals should be selective when prescribing antibiotics for pregnant women.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

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Maternal antibiotic exposure during pregnancy and the risk of allergic diseases in childhood: A meta‐analysis

Zhong

Zhang

Wang

et al. 2020

Pediatric Allergy Immunology

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“…A longitudinal follow-up study found that early antibiotic exposures appeared to increase higher risk for atopy among children with <2 than with ≥2 household pets, as well as among children who were breastfed ≥4 than <4 months [ 14 ]. However, few studies considered associations of early antibiotics exposure with childhood health outcomes among children with different individual characteristics and early exposures [ 1 , 20 , 29 , 30 , 31 ], particularly in China where prevalences of asthma and allergies have rapidly increased in the past 20 years [ 32 , 33 , 34 , 35 ] and where antibiotics have been overused [ 1 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

Zou

Liu

Huang

et al. 2020

IJERPH

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Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011–2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child’s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95–2.37), croup (1.46, 1.24–1.73), wheeze (1.44, 1.30–1.60), asthma (1.38, 1.19–1.61), food allergy (1.29, 1.13–1.46), and allergic rhinitis (1.23, 1.07–1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25–1.52), dry cough (1.27, 1.13–1.42), atopic dermatitis (1.25, 1.09–1.43), wheeze (1.23, 1.10–1.38), and rhinitis symptoms (1.15, 1.04–1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.

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“…In addition, the frequent use of antibiotics during pregnancy is associated with a higher risk for wheeze and asthma development later in life. A meta-analysis revealed a positive association between antibiotic use and the risk of wheeze and asthma (OR 1.28) [79]. Since antibiotics influence the maternal bacterial composition, the microbiome transferred to the newborn during delivery might have a high impact on the development of asthma due to alterations in the Th1/Th2 immune balance [80].…”

Section: Infections and Antibioticsmentioning

confidence: 99%

Role of early life immune regulation in asthma development

2019

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Development of childhood asthma is complex with a strong interaction of genetic, epigenetic, and environmental factors. Ultimately, it is critical how the immune system of a child responds to these influences and whether effective strategies for a balanced and healthy immune maturation can be assured. Pregnancy and early childhood are particularly susceptible for exogenous influences due to the developing nature of a child's immune system. While endogenous influences such as family history and the genetic background are immutable, epigenetic regulations can be modulated by both heredity and environmental exposures. Prenatal influences such as a mother's nutrition, smoking, or infections influence the complex interplay of innate and adaptive immune regulation as well as peri-and postnatal influences including mode of delivery. Early in life, induction and continuous training of healthy maturation include balanced innate immunity (e.g., via innate lymphoid cells) and an equilibrium of T-cell subpopulations (e.g., via regulatory T cells) to counterregulate potential pro-inflammatory or exuberant immune reactions. Later in childhood, rather compensatory immune mechanisms are required to modulate deviant regulation of a child's already primed immune trajectory. The specific effects of exogenous and endogenous influences on a child's maturing immune system are summarized in this review, and its importance and potential intervention for early prevention and treatment strategies are delineated.

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Trimester-specific association between antibiotics exposure during pregnancy and childhood asthma or wheeze: the role of confounding

Cited by 27 publications

References 43 publications

Maternal antibiotic exposure during pregnancy and the risk of allergic diseases in childhood: A meta‐analysis

Maternal antibiotic exposure during pregnancy and the risk of allergic diseases in childhood: A meta‐analysis

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

Role of early life immune regulation in asthma development

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