Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
Eur Respir J. 2018 Jul 4;52(1). doi: 10.1183/13993003.02070-2017. Print 2018 Jul.
Antibiotic use during infancy alters gut microbiota and immune development and is associated with an increased risk of childhood asthma. The impact of prenatal antibiotic exposure is unclear. We sought to characterise the association between prenatal antibiotic exposure and childhood asthma.We performed a population-based cohort study using prescription records, hospitalisation records and physician billing claims from 213 661 mother-child dyads born in Manitoba, Canada between 1996 and 2012. Associations were determined using Cox regression, adjusting for maternal asthma, postnatal antibiotics and other potential confounders. Sensitivity analyses evaluated maternal antibiotic use before and after pregnancy.36.8% of children were exposed prenatally to antibiotics and 10.1% developed asthma. Prenatal antibiotic exposure was associated with an increased risk of asthma (adjusted hazard ratio (aHR) 1.23, 95% CI 1.20-1.27). There was an apparent dose response (aHR 1.15, 95% CI 1.11-1.18 for one course; aHR 1.26, 95% CI 1.21-1.32 for two courses; and aHR 1.51, 95% CI 1.44-1.59 for three or more courses). Maternal antibiotic use during 9 months before pregnancy (aHR 1.27, 95% CI 1.24-1.31) and 9 months postpartum (aHR 1.32, 95% CI 1.28-1.36) were similarly associated with asthma.Prenatal antibiotic exposure was associated with a dose-dependent increase in asthma risk. However, similar associations were observed for maternal antibiotic use before and after pregnancy, suggesting the association is either not directly causal, or not specific to pregnancy.
在婴儿期使用抗生素会改变肠道微生物群和免疫发育，并增加儿童哮喘的风险。产前抗生素暴露的影响尚不清楚。我们旨在描述产前抗生素暴露与儿童哮喘之间的关联。
我们使用来自加拿大马尼托巴省 213661 对母婴对子在 1996 年至 2012 年期间的处方记录、住院记录和医生计费记录进行了一项基于人群的队列研究。使用 Cox 回归确定关联，调整了母亲哮喘、产后抗生素和其他潜在混杂因素。敏感性分析评估了妊娠前后母亲抗生素的使用情况。
36.8%的儿童在产前接触过抗生素，10.1%的儿童患有哮喘。产前抗生素暴露与哮喘风险增加相关（调整后的危害比 (aHR) 1.23，95%CI 1.20-1.27）。存在明显的剂量反应（一个疗程的 aHR 1.15，95%CI 1.11-1.18；两个疗程的 aHR 1.26，95%CI 1.21-1.32；三个或更多疗程的 aHR 1.51，95%CI 1.44-1.59）。妊娠前 9 个月（aHR 1.27，95%CI 1.24-1.31）和产后 9 个月（aHR 1.32，95%CI 1.28-1.36）母亲抗生素的使用也与哮喘相似。
产前抗生素暴露与哮喘风险呈剂量依赖性增加相关。然而，在妊娠前后观察到类似的母亲抗生素使用与哮喘的关联，表明该关联要么不是直接因果关系，要么不是特定于妊娠的。
