Malaghan Institute of Medical Research, Wellington, New Zealand.
Department of Impact and Evaluation, German Children and Youth Foundation, Berlin, Germany.
Allergy. 2022 Nov;77(11):3233-3248. doi: 10.1111/all.15404. Epub 2022 Jun 27.
Antibiotic use during pregnancy may increase the risk for asthma in children. We performed a meta-analysis assessing prenatal antibiotic exposure and the risk for childhood wheeze or asthma, as well as for diseases associated with the atopic march. A systematic literature search protocol (PROSPERO-ID: CRD42020191940) was registered and searches were completed using Medline, Proquest, Embase, and the Cochrane central register of controlled trials. Screening for inclusion criteria: published in English, German, French, Dutch, or Arabic, intervention (use of any antibiotic at any time point during pregnancy), and disease (reporting atopic disease incidence in children with a primary outcome of asthma or wheeze), and exclusion criteria: reviews, preclinical data, and descriptive studies, yielded 27 studies. Study quality was assessed using the Newcastle-Ottawa Assessment Scale. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Our meta-analysis demonstrates that antibiotic use during pregnancy is associated with an increased relative risk (RR) of developing wheeze RR 1.51 (95% CI: 1.17-1.94) or asthma RR 1.28 (95% CI 1.22-1.34) during childhood. Assessment of the atopic march in association with asthma or wheeze revealed that antibiotic use during pregnancy also increases the risk for eczema/dermatitis RR 1.28 (95% CI: 1.06-1.53) and allergic rhinitis RR 1.13 (95% CI: 1.02-1.25). One study found an increase in food allergy RR 1.81 (95% CI: 1.11-2.95). Maternal antibiotic use during pregnancy is associated with an increased risk for wheeze or asthma development in children, as well as for diseases involved in the atopic march. There was high heterogeneity in the data, and the certainty of the evidence was determined to be low quality, highlighting the need for more high-quality studies on this topic. These results have importance for antibiotic stewardship throughout the prenatal period. This work was supported by the Deutsche Forschungsgemeinschaft and the Konrad Adenauer Foundation.
孕期使用抗生素可能会增加儿童哮喘的风险。我们进行了一项荟萃分析，评估了产前抗生素暴露与儿童喘息或哮喘风险，以及与特应性进行曲相关的疾病风险。我们使用了 Medline、Proquest、Embase 和 Cochrane 对照试验中心注册库，制定了系统文献检索方案（PROSPERO-ID：CRD42020191940）并完成了检索。纳入标准的筛选：以英文、德文、法文、荷兰文或阿拉伯文发表，干预措施（在孕期的任何时间点使用任何抗生素），疾病（报告儿童特应性疾病的发病率，主要结局为哮喘或喘息），排除标准：综述、临床前数据和描述性研究，共纳入 27 项研究。使用纽卡斯尔-渥太华评估量表评估研究质量。使用推荐评估、制定与评价（GRADE）方法评估证据质量。我们的荟萃分析表明，孕期使用抗生素与儿童喘息（RR 1.51，95%CI：1.17-1.94）或哮喘（RR 1.28，95%CI：1.22-1.34）的相对风险增加相关。评估与哮喘或喘息相关的特应性进行曲发现，孕期使用抗生素也会增加特应性皮炎/湿疹（RR 1.28，95%CI：1.06-1.53）和过敏性鼻炎（RR 1.13，95%CI：1.02-1.25）的风险。一项研究发现食物过敏的风险增加（RR 1.81，95%CI：1.11-2.95）。孕期母亲使用抗生素与儿童喘息或哮喘的发生风险增加以及特应性进行曲相关疾病相关。数据存在高度异质性，证据质量被确定为低质量，这突出表明需要对这一主题进行更多高质量的研究。这些结果对整个孕期的抗生素管理具有重要意义。这项工作得到了德国研究基金会和康拉德·阿登纳基金会的支持。
