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