A recent systematic review and meta-analysis suggests that prenatal antibiotic exposure may be associated with a range of long-term health issues in children, including asthma, food allergies, obesity, cerebral palsy, and even cancer. The study, published last week in The Journal of Infection, underscores the need for careful antibiotic use during pregnancy, as antibiotics are among the most prescribed drugs to pregnant women.
The review, led by researchers from the University of Melbourne and the University of Fribourg, analyzed 158 studies involving 21.9 million children from various countries. The analysis found that prenatal exposure to antibiotics was linked to 23 adverse health outcomes, including asthma (odds ratio (OR) 1.36), food allergies (OR 1.25), obesity (OR 1.36), cerebral palsy (OR 1.25), inflammatory bowel disease (OR 2.03), and cancer (OR 1.13), among others.1
Other conditions associated with prenatal antibiotic exposure included atopic dermatitis, allergic rhinoconjunctivitis, wheezing, and epilepsy or febrile seizures. Although these findings are concerning, the authors emphasize that causality cannot be directly inferred from the study. Rather, the research highlights a potential link between antibiotic use during pregnancy and long-term health risks.1
One of the study’s key findings was that antibiotic exposure later in pregnancy, particularly in the third trimester, was more strongly associated with adverse health outcomes. Additionally, repeated courses of antibiotics appeared to increase the risks. Antibiotics commonly associated with higher risks included penicillins and macrolides, compared to other drug classes such as tetracyclines or fluoroquinolones.1
Also, a recent meta-analysis published earlier in the same journal found that approximately 23.6% of women worldwide use antibiotics during pregnancy, with notable regional and income-based variations. The highest prevalence was found in low-income countries (45.3%) and the Western Pacific (34.4%). The study also noted an increase in antibiotic use over time in the Americas and Western Pacific. While most studies were of low bias risk, considerable variability in the reported prevalence suggests potential underestimation of antibiotic use, possibly due to publication bias.2
Understanding the Mechanisms
What You Need To Know
A systematic review and meta-analysis found that prenatal antibiotic exposure is associated with a range of long-term health issues in children, including asthma, food allergies, and even cancer.
Antibiotic use during pregnancy, particularly in the third trimester and with repeated courses, was more strongly linked to adverse health outcomes, with penicillins and macrolides associated with higher risks.
The study highlights the need for better antibiotic stewardship during pregnancy, given the widespread use of antibiotics and potential risks, while also calling for further research to understand the long-term effects.
While the study does not establish definitive mechanisms, the authors propose several possible explanations for the observed associations. Research suggests that antibiotics may disrupt the gut microbiome, which is critical in immune and metabolic functions. Disruptions to the microbiome during critical stages of fetal development could lead to immune dysregulation, metabolic disturbances, or changes in brain development, contributing to long-term health issues like obesity and neurobehavioral disorders.1
The authors also point to the gut-brain axis, the connection between the gut microbiome and brain function, as a possible pathway through which antibiotics may affect neurodevelopment. Alterations to this system during early pregnancy could influence cognitive and behavioral outcomes in children.1
The findings highlight the need for antibiotic stewardship during pregnancy to reduce long-term risks to children. While antibiotics are necessary for treating infections, their use should be carefully considered to prevent unnecessary exposure. The analysis calls for more research into the long-term effects of prenatal antibiotic use and stresses the need for greater awareness of the risks. As antibiotics are widely prescribed during pregnancy, careful use is important to protect maternal and child health.
References
1. Duong, Quynh A et al. The association between prenatal antibiotic exposure and adverse long-term health outcomes in children: a systematic review and meta-analysis. Journal of Infection, Volume 0, Issue 0, 106377. doi: 10.1016/j.jinf.2024.106377
2. Orwa SA, Versporten A, Gudnadottir U, et al. Global prevalence of antibiotic consumption during pregnancy: A systematic review and meta-analysis. Infect Dis Pract. 2024;27(1): [page range]. doi:10.1016/j.idp.2024.05.003
