Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clin Infect Dis. 2021 Feb 1;72(3):455-462. doi: 10.1093/cid/ciaa085.
The potential for prenatal antibiotic exposure to influence asthma risk is not clear. We aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma.
We conducted a population-based cohort study of 84 214 mother-child dyads to examine the association of prenatal antibiotic exposure and childhood asthma using multivariable logistic regression models.
Sixty-four percent of pregnant women received antibiotics. Prenatal antibiotic exposure was associated dose-dependently with increased odds of childhood asthma (adjusted odds ratio [aOR] for interquartile increase of 2 courses [interquartile range, 0-2], 1.26 [95% confidence interval {CI}, 1.20-1.33]). Among children exposed to at least 1 course in utero, the effect of timing at the first course was moderated by total maternal courses. Among pregnant women receiving a single antibiotic course, timing of exposure had no effect on childhood asthma risk. Among women receiving > 1 course, early exposure of the first course was associated with greater childhood asthma risk. Compared to narrow spectrum-only antibiotic use, broad spectrum-only antibiotic exposure was associated with increased odds of asthma (aOR, 1.14 [95% CI, 1.05-1.24]). There were effect modifications (P < .001) by maternal asthma on total courses, and on timing of the first course, significant only among those without maternal asthma.
Increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk. Our study provides important evidence supporting judicious prenatal antibiotic use, particularly timing of use and choice of antibiotics, in preventing subsequent childhood asthma.
产前抗生素暴露是否会影响哮喘风险尚不清楚。我们旨在确定产前抗生素暴露的时机、剂量和谱对儿童哮喘风险的影响。
我们进行了一项基于人群的 84214 对母婴对子的队列研究，使用多变量逻辑回归模型来检查产前抗生素暴露与儿童哮喘之间的关联。
64%的孕妇接受了抗生素治疗。产前抗生素暴露与儿童哮喘的发生呈剂量依赖性相关（调整后的比值比[OR]为 2 个疗程（四分位距[IQR]为 0-2]的中值增加[95%置信区间[CI]，1.26[1.20-1.33]）。在至少有 1 个疗程暴露于宫内的儿童中，第一个疗程的时间与总产妇疗程有关。在接受单次抗生素疗程的孕妇中，暴露时间对儿童哮喘风险没有影响。在接受>1 个疗程的孕妇中，第一疗程的早期暴露与更高的儿童哮喘风险相关。与仅窄谱抗生素使用相比，仅广谱抗生素暴露与哮喘的发生风险增加相关（OR，1.14[95%CI，1.05-1.24]）。总疗程和第一疗程时间的效应修饰（P<.001）在有或没有母亲哮喘的情况下都存在显著差异。
累积剂量增加、妊娠早期第一疗程和广谱抗生素暴露与儿童哮喘风险相关。我们的研究为支持在预防随后发生的儿童哮喘中合理使用产前抗生素，特别是使用时间和抗生素选择，提供了重要证据。
