Elsevier

The Journal of Pediatrics

Volume 162, Issue 4, April 2013, Pages 832-838.e3
The Journal of Pediatrics

Original Article
Use of Antibiotics during Pregnancy Increases the Risk of Asthma in Early Childhood

https://doi.org/10.1016/j.jpeds.2012.09.049Get rights and content

Objectives

To investigate the hypothesis that mother's use of antibiotics in pregnancy could influence asthma and eczema in early life.

Study design

Subjects were included from the Copenhagen Prospective Study on Asthma in Childhood cohort of children born of mothers with asthma (N = 411). Severe asthma exacerbations and eczema were diagnosed by research unit physicians. Replication was sought in children from the Danish National Birth Cohort (N = 30 675). Asthma outcomes were hospitalization and use of inhaled corticosteroids. Eczema was defined by an algorithm developed from cases of clinically verified eczema. All children were followed to age 5 years in a cohort study design.

Results

The Copenhagen Prospective Study on Asthma in Childhood data showed increased risk of asthma exacerbation (hazard ratio 1.98 [95% CI 1.08-3.63]) if mothers had used antibiotics during third trimester. The Danish National Birth Cohort confirmed increased risk of asthma hospitalization (hazard ratio 1.17 [1.00-1.36]), and inhaled corticosteroids (1.18 [1.10-1.27]) in the children if mothers used antibiotics any time during pregnancy. In the subgroup of mothers using antibiotics for nonrespiratory infection, the children also had increased risk of asthma.

Conclusion

We found increased risk of asthma associated with maternal antibiotic use in a clinical study of a birth cohort with increased risk of asthma and replicated this finding in an unselected national birth cohort, and in a subgroup using antibiotics for nonrespiratory infections. This supports a role for bacterial ecology in pre- or perinatal life for the development of asthma.

Section snippets

The Copenhagen Prospective Study on Asthma in Childhood Birth Cohort Study

The Copenhagen Prospective Study on Asthma in Childhood (COPSAC) birth cohort study is a prospective clinical study of 411 infants born between 1998 and 2001 to mothers with a history of asthma.1, 7, 8 History of exposure including mother's use of antibiotics and paracetamol during the third trimester of pregnancy was collected at the enrollment visit. Maternal use of antibiotics for nonrespiratory infection was defined by maternal diagnoses of urinary tract infection, skin/genital infection,

COPSAC

The COPSAC birth cohort and the study subpopulations are described in Table II (available at www.jpeds.com). Sixty-three (15.3%) mothers of the 411 children included in the COPSAC cohort were treated with antibiotics during third trimester of pregnancy, 34 with antibiotics for nonrespiratory infection. Seventy-one (17%) of the children were lost to follow-up during the first 5 years of life, of these 12 had mothers who received antibiotics.

Asthma

Fifty-seven children had at least 1 exacerbation within

Discussion

We found that mother's use of antibiotics was associated with an increased risk of asthma, but not eczema, in the young child, and the effect was robust when restricted to antibiotics for nonrespiratory infections suggesting that the antibiotic use was not confounded by the mother's asthma phenotype or risk.

The clinical birth cohort study COPSAC provided highly specific diagnoses based on dense clinically verified follow-up data on 411 high risk children. Using the large population based DNBC

References (20)

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The Copenhagen Prospective Study on Asthma in Childhood is funded by private and public research funds (available at www.copsac.com). Core support is provided by the Lundbeck Foundation, the Pharmacy Foundation of 1991, Augustinus Foundation, the Danish Medical Research Council, and the Danish Pediatric Asthma Center. The Danish National Birth Cohort was established, developed, and supported by the Danish National Research Foundation. Additional support was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation. The study was funded by the Health Foundation and Augustinus Foundation. The funding agencies did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest.

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