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Prenatal Exposure to Antibiotics May Increase Risk for Long-Term Health Problems in Children
The potential adverse outcomes include asthma, food allergies, cerebral palsy, and cancer, according to a recent systematic review and meta-analysis.
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 in The Journal of Infection, underscores the need for judicious use of antibiotics during pregnancy, particularly as they are among the most commonly prescribed drugs during pregnancy, according to study authors.
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 an increased risk for 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
Prenatal antibiotic exposure was also associated with a greater risk for atopic dermatitis, allergic rhinoconjunctivitis, wheezing, and epilepsy or febrile seizures. Investigators stress that while the findings are concerning, the study does not allow them to infer causality, only that 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 penicillin drugs and macrolides, compared to other drug classes such as tetracyclines or fluoroquinolones.1
Another 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
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 essential role for antibiotic stewardship during pregnancy. While the drugs are necessary to treat infection, 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.
