Antibiotic use during childbirth influences pediatric obesity risk
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Intrapartum antibiotic prophylaxis during labor and delivery is associated with a 0.56-unit increase in BMI z scores among infants aged 1 year, according to study data.
“Two important factors that influence the initial establishment of the gut microbiota are delivery mode at birth — vaginal or cesarean section — and early life antibiotic exposure,” Dana Lowry, MSc, a doctoral student in the department of biochemistry and molecular biology at the University of Calgary, Alberta, Canada, said during a presentation at the European and International Congress on Obesity virtual meeting. “Either of these events can contribute to a disruption in the intestinal community and lead to microbe-dependent effects that influence inflammation, metabolic signaling and adiposity.”
Antibiotics are the most common medication prescribed to children, and approximately 25% of pregnant women are prescribed antibiotic therapy, Lowry said, adding that a large body of evidence links antibiotic exposure in early life to increased obesity risks in childhood and adulthood.
Intrapartum antibiotic prophylaxis, or IAP, is a routine procedure to protect against infection during cesarean delivery or to prevent the transmission of group B streptococcus from mother to neonate.
“Despite causal evidence from animal studies and a number of results from large human studies, there is still conflicting evidence over whether early life antibiotic exposure does result in an increased obesity risk,” Lowry said. “Studying the effect of perinatal antibiotic use is difficult; that is because of the number of factors to account for. These include age at which antibiotics were used, the number of times exposed, type of antibiotic — broad spectrum vs. a narrow spectrum — and then how the child was delivered and whether they were breastfed. We know these factors contribute to the overall establishment of that microbiota.”
Lowry and colleagues investigated the association between maternal antibiotic exposure during birth and/or during pregnancy and BMI z scores in children at ages 1, 2 and 3 years, using data from the All Our Families cohort in Alberta, Canada, a longitudinal pregnancy cohort designed to investigate relationships between parental well-being and outcomes for children and families. Researchers recruited 3,387 women between May 2008 and December 2010. Using data from obstetrical birth records and questionnaires, researchers identified 1,303 women who had IAP exposure and 1,943 women who self-reported antepartum antibiotic exposure. Infant BMI was obtained via questionnaires at ages 1, 2 and 3 years; BMI z scores were age- and sex-specific and calculated according to 2006 WHO standards.
In unadjusted models, researchers observed a significant association between IAP and BMI z scores at ages 1 and 2 years; however, there was no association between prenatal antibiotic use and BMI z scores.
After adjustment for 11 variables, IAP exposure was associated with a 0.56-unit increase in BMI z score at 1 year; any differences were attenuated by years 2 and 3, Lowry said.
Lowry noted that there is a lack of information regarding antibiotic dose, timing and type, as well as limited information on breastfeeding and smoking status for study participants.
“Our findings indicate that exposure to antibiotics during birth may contribute to the development of childhood overweight and obesity at 1 year,” Lowry said. “Future directions include investigating the mechanism for this weight association and a longer follow-up study into adolescence and adulthood to explore the longer-term effects.”
Reference:
- All Our Families study. Available at: https://allourfamiliesstudy.com/our-cohort/. Accessed Sept. 2, 2020.
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Fionnuala McAuliffe, MD, MBBCh, FRCOG
This is a very interesting topic. Some studies suggest that up to one-third of all women receive antibiotics at some time in pregnancy, and a big focus for obstetricians is prevention of infection and sepsis. We tend to have a low threshold for giving antibiotics to prevent infection in the mother and perhaps should also consider the baby when we do.
The data shows that it seems to be intrapartum antibiotics, rather than prenatal antibiotics, that are associated with childhood BMI z score. If you have attended a cesarean section you will see that in many countries we give women antibiotics routinely; one consideration is whether we could or should give them after baby is born instead of beforehand.
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Lowry D. Antibiotics given during labor and birth increases body mass index z scores in children at 1 year of age. Presented at: European and International Congress on Obesity Annual Meeting; Sept. 1-4, 2020; (virtual meeting).
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