Prenatal antibiotic exposure and the risk of atopic dermatitis in
children: a nationwide population-based cohort study.
Abstract
Background: Atopic dermatitis (AD) contributes to substantial
social and financial costs in public health care systems. Antibiotic
exposure during pregnancy has been proposed as a risk factor, but
findings remain inconsistent. The aim of this study was to investigate
the association between prenatal antibiotic use and childhood AD.
Methods: We performed a population-based cohort study using
data collected from the Taiwan Maternal and Child Health Database from
2009 to 2016. Associations were determined using Cox proportional
hazards model and were adjusted for several potential covariates,
including maternal atopic disorders and gestational infections. Subgroup
analyses evaluated the influence of postnatal infant
antibiotic/acetaminophen use on the association between prenatal
antibiotic exposure and childhood AD diagnosed after 1 year of age.
Results: A total of 1288343 mother-child pairs were identified
and 39.5% received antibiotics prenatally. Maternal antibiotic use
during pregnancy was slightly positively associated with childhood AD
(aHR 1.05, 95% CI 1.04-1.06), especially in the first and second
trimesters. An apparent dose-response pattern was observed with an 11%
increased risk when the exposure was ≥5 courses prenatally (aHR 1.11,
95% CI 1.09-1.14). Subgroup analysis showed the positive association
remained significant regardless of postnatal antibiotic use; however, a
negative association was found in children without postnatal infant
acetaminophen use (aHR 1.02, 95% CI 0.97-1.07). Conclusion:
Maternal antibiotic use during pregnancy was associated with increased
risk of childhood AD in a dose-related manner. Possible confounders
existed between prenatal antibiotics and postnatal infant acetaminophen
use in the subgroup analysis. Further research may be warranted to
investigate this variable using a prospectively designed study, and also
to examine whether or not this association is specifically related to
pregnancy.