Antibiotic use during pregnancy linked to increased risk of skin conditions, asthma in offspring

Antibiotic use during pregnancy is associated with an increased risk of asthma, eczema, psoriasis and allergic rhinitis in children. Antibiotics account for 80% of medications that are prescribed during pregnancy, and about 20% to 25% of pregnant women receive at least one course of an antibiotic, according to a study in Allergy. Their use is of concern because of their effect on altering the maternal gut microbiome which is increasingly understood as playing important roles in both maternal and fetal health—especially as it relates to the developing immune system. When it comes to the development of a newborn’s immune system, the time immediately following birth to approximately three months of age are important for immune-microbe interactions in the infant intestine that establish immune tolerance. Antibiotics alter gut microbiome composition. Read: Point-of-care testing doesn’t change antibiotic use in children in the ED, Finnish study Studies in the literature show mixed results with respect to antibiotic use during pregnancy and atopic disorders. Some suggest other explanations for the apparent risk of antibiotics use and progression of the atopic march which can eventually lead to asthma, the authors noted. The atopic march is a term used to describe the development of allergic conditions in early life (beginning with dermatitis) that progress to additional allergies such as food allergy or asthma. The researchers conducted a meta-analysis to ascertain whether prenatal antibiotic exposure is associated with a subsequent risk of developing a pattern of atopic conditions that could culminate in childhood asthma. A key question was whether antibiotic use during pregnancy can affect the propensity for the atopic march. The researchers included studies published in any of five languages: English, German, French, Dutch, or Arabic from multiple databases. Studies had to address the use of any antibiotic at any time point during pregnancy, and report on atopic disease incidence in the offspring with a primary outcome of asthma or wheeze. A total of 27 studies published from 2002 to 2020 were included in the analyses; 11 were prospective and 16 were retrospective. Twenty investigated prenatal antibiotic exposure and asthma, nine investigated wheeze, two looked at atopic sensitization, one was of food allergy, five were of eczema or dermatitis, and three investigated allergic rhinitis. Results showed that the most significant associations between antibiotic use during pregnancy and the development of atopic disease were for asthma, wheeze and food allergy. Overall, the 20 asthma studies showed a very strong association between prenatal antibiotic exposure and the risk of developing asthma in childhood. “In 18 of 20 studies, this relationship was statistically significant,” the study said. The researchers divided the antibiotics into six different classes to see if any specific antibiotics were associated with greater risks than others. Results showed that most antibiotic classes other than cephalosporins were associated with increased risk for childhood asthma. However, coauthor Dr. Melanie Conrad, from the Charité Medical University said this finding should be interpreted with caution. “The results for cephalosporin were likely due to the small sample size and heterogeneity of the studies,” she told the Medical Post in an email. Indeed, “most antibiotics (and thus any alteration of the maternal gut microbiome during pregnancy) are associated with the development of childhood allergies and asthma.” But there was a scarcity of studies comparing antibiotic types to each other, so this analysis should be interpreted with caution, she said. Of the nine studies that reported on wheeze, eight showed a positive trend between prenatal antibiotic exposure and the development of childhood wheeze. In half of the studies, the relationship was statistically significant. The one study investigating food allergy found a significant association with antibiotic use during pregnancy. The five studies investigating the development of dermatitis or eczema showed prenatal exposure to antibiotics is a risk factor for this too. The studies looking at allergic rhinitis also found that antibiotic use during pregnancy was associated with increased risk but some of these studies were underpowered, the study said. Of the two studies of atopic sensitization, results were mixed. The trimester when antibiotics are taken by women could make a difference, for at least some conditions. The study showed that only antibiotics administered during the third trimester had a significant association with relative risk of childhood wheeze, but an analysis of eight studies showed there was a significant effect of antibiotics taken during any trimester was associated with increased risk of developing childhood asthma. Another recent metanalysis in Pediatric Allergy Immunology in 2020 by researchers in China had similar findings. Here, researchers analyzed 26 published studies and concluded “that maternal antibiotic use during pregnancy might increase the risk of asthma/wheeze and eczema/atopic dermatitis but not food allergy in children.” An overview of the topic in BMC Medicine from 2016 by researchers in Israel described the role of microbiota in pregnancy, touches on the history of antibiotic use in pregnancy, the effect of antibiotics and addressed longer term outcomes. The researchers also acknowledged there is a role for antibiotics, when needed during pregnancy. However, “antibiotic treatment, while at times lifesaving, can also have detrimental consequences. A single course of antibiotics perturbs bacterial communities, with evidence that the microbial ecosystem does not return completely to baseline following treatment. Antibiotics in pregnancy should be used only when indicated, choosing those with the narrowest range possible.” The researchers added that the use of antibiotics during pregnancy has been found in various studies to be associated with increased risk of asthma in early childhood, increased risk of childhood epilepsy, and an increased risk of childhood obesity. “Of course, the argument could be made that the primary maternal infection was the cause for the increased risk of these conditions, rather than the treatment itself. Nevertheless, we suggest that antibiotics in pregnancy may affect the bacterial ecosystem of the mother as well as that of the fetus, and therefore that their use should be carefully considered based on what is known, and what remains unknown, regarding their effects,” they wrote.

Antibiotic use during pregnancy linked to increased risk of skin conditions, asthma in offspring

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