Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
College of Nursing, Rady Faculty of Health Sciences, University of Manitoba & Health Sciences Centre, Winnipeg, MB, Canada.
J Psychiatr Res. 2021 May;137:621-633. doi: 10.1016/j.jpsychires.2020.11.003. Epub 2020 Nov 5.
Mood and anxiety disorders (MADs) are common conditions with multiple aetiologies. Exposure to antibiotics has been proposed as a possible risk factor in animal studies. We aimed to assess maternal antibiotic use in pregnancy and child antibiotic use in the first three years of life, collectively called early life, as potential risk factors for subsequent development of MADs during childhood and adolescence.
A population-based retrospective cohort study was conducted including 221,139 children born in Manitoba, Canada between 1996 and 2012. Exposure was defined as having filled one or more antibiotic prescriptions during early life. Children were followed until the earliest MADs diagnoses, 19th birthday, migration, death, or end of the study period. We computed crude and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) using Cox proportional hazard regression.
Children born to mothers who received one or more antibiotic courses in pregnancy had significantly higher rates of MADs compared with non-exposed children (aHR 1.08, 95% CI 1.03,1.13). Overall antibiotic exposure during the first three years of life was not significantly associated with MADs (aHR 1.00, 95% CI 0.94,1.07). A significantly increased risk of MADs was observed after postnatal exposure to tetracyclines, aminoglycosides, quinolones (33%) or sulfonamides and trimethoprim (28%). Postnatal exposure to macrolides, lincosamides, and streptogramins significantly reduced the risk of MADs by 16%.
Early life exposure to antibiotics is associated with different risk effects on MADs in children. The apparent associations may have been confounded by indication and may not be clinically meaningful.
心境和焦虑障碍（MADs）是常见的疾病，其病因众多。动物研究提出，接触抗生素可能是一个风险因素。我们旨在评估孕妇在妊娠期间使用抗生素和儿童在生命的头三年中使用抗生素，统称生命早期，作为儿童和青少年时期随后发展 MADs 的潜在危险因素。
进行了一项基于人群的回顾性队列研究，纳入了 1996 年至 2012 年间在加拿大马尼托巴省出生的 221,139 名儿童。暴露定义为在生命早期期间有过一次或多次抗生素处方。儿童随访至最早出现 MADs 诊断、19 岁生日、移民、死亡或研究结束。我们使用 Cox 比例风险回归计算了未暴露儿童和暴露儿童的粗和调整后的危险比（aHR）及其相应的 95%置信区间（CI）。
与未暴露的儿童相比，母亲在妊娠期间接受一个或多个抗生素疗程的儿童出现 MADs 的比率显著更高（aHR 1.08，95%CI 1.03，1.13）。生命的头三年中总体抗生素暴露与 MADs 无显著相关性（aHR 1.00，95%CI 0.94，1.07）。在出生后接触四环素、氨基糖苷类、喹诺酮类（33%）或磺胺类和甲氧苄啶（28%）后，观察到 MADs 的风险显著增加。在出生后接触大环内酯类、林可酰胺类和糖肽类抗生素显著降低 MADs 的风险 16%。
生命早期暴露于抗生素与儿童 MADs 的不同风险效应相关。明显的关联可能受到指征的混杂，并且可能没有临床意义。
