Key message:
Prenatal antibiotic use was positively associated with atopic dermatitis
in childhood in a dose-response manner. Further research should be
conducted to examine whether or not this association was specific to
during pregnancy.
Introduction
Atopic dermatitis (AD) is an inflammatory skin disorder characterized by
recurrent pruritic eczematous lesions. The prevalence of AD varies among
different geographic areas, with a rate of up to 20% in the pediatric
population.1 AD manifests mostly in infancy with an
age of onset before 6 years in about 80% of
patients.2 Dermatitis, including AD, is responsible
for the majority of the global skin disease burden, leading to
substantial social and financial costs.3
The cause of AD may be multifactorial, including genetic susceptibility,
environmental exposure, immune dysregulation, and
inflammation.4,5 Among the environmental variables,
antibiotic use during pregnancy and in early life are thought to be risk
factors of AD and have been discussed in several studies and
meta-analyses. Antibiotics account for nearly 80% of prescribed
medications during pregnancy and the estimated rate of antibiotic use
during this period was reported to be 20-25%.6 The
changes in gut microbiota and dysbiosis after antibiotic use may be one
of the reasons for subsequent AD development.7
Tsakok el al. conducted the first systematic review and meta-analysis of
the effects of prenatal antibiotic exposure on AD. The pooled odds ratio
(OR), which was 1.3 (95% CI: 0.86-1.95), indicated there was no
association, although the estimate was elevated.8Three subsequent meta-analysis showed a positive
association.9-11 In a study by Cait et al., the risk
of eczema/dermatitis was increased in their pooled data (RR 1.28; 95%
CI: 1.06 –1.53). However, high heterogeneity among the data was also
mentioned by the authors. Similar findings were also noted in the other
2 meta-analyses. The reasons for the high heterogeneity may be the
different methods of data collection (some were by questionnaire or
telephone interviews), inconsistent outcome measurements, and
differences in methods used to control the variables among studies.
This study employed a cohort study design with a large sample from
Taiwan’s national healthcare system and aimed to examine the association
between maternal antibiotic use during pregnancy and childhood AD,
taking the timing of exposure during pregnancy into account.
Methods