Risk of Immune-related Diseases in Childhood after Intrapartum Antibiotic Exposure.

BACKGROUND: Intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease in newborn infants, but it influences gut microbiota development. Gut microbiota composition is in turn associated with immune-related diseases in childhood.

OBJECTIVE: We hypothesized that intrapartum antibiotic exposure is associated with immune-related diseases in childhood.

STUDY DESIGN: We conducted a population-based cohort study of vaginally delivered children. We retrieved data on intrapartum antibiotic exposure from structured electronic medical records and obtained outcome data on childhood autoimmune, allergic, and obstructive airway diseases from comprehensive national registers. We used Cox regression analysis adjusted for maternal and neonatal covariates and regarded death as a competing risk in the analyses.

RESULTS: Study population comprised 45 575 vaginally born children, of whom 9733 (21%) had been exposed to intrapartum antibiotics. Intrapartum antibiotic exposure was associated with autoimmune disease diagnosis (adjusted hazard ratio 1.28 [95% CI 1.02- 1.62]) corresponding to 22% (95% CI 6% - 39%) as a theoretical population-attributable fraction. Intrapartum antibiotic exposure was not associated with diagnoses of allergic (adjusted hazard ratio 1.08 [95% CI 0.97 - 1.20]) or obstructive airway diseases (adjusted hazard ratio 1.04 [95% CI 0.96 - 1.14]).

CONCLUSIONS: Intrapartum antibiotic exposure may be associated with an increased risk of autoimmune diseases in childhood. This finding supports the efforts to develop more specific group B streptococcal disease prevention strategies in the future.