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Use of Antibiotics during Pregnancy Increases the Risk of Asthma in Early Childhood - 25/03/13

Doi : 10.1016/j.jpeds.2012.09.049 
Lone Graff Stensballe, MD, PhD 1, 2, , Jacob Simonsen, MSc, PhD 2, Signe M. Jensen, MSc 1, Klaus Bønnelykke, MD, PhD 1, Hans Bisgaard, MD, DMSc 1
1 Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, and The Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark 
2 Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark 

Reprint requests: Lone Graff Stensballe, MD, PhD, Statens Serum Institut, 5-Ørestads Boulevard, DK-2300 Copenhagen, Denmark.

Abstract

Objectives

To investigate the hypothesis that mother’s use of antibiotics in pregnancy could influence asthma and eczema in early life.

Study design

Subjects were included from the Copenhagen Prospective Study on Asthma in Childhood cohort of children born of mothers with asthma (N = 411). Severe asthma exacerbations and eczema were diagnosed by research unit physicians. Replication was sought in children from the Danish National Birth Cohort (N = 30675). Asthma outcomes were hospitalization and use of inhaled corticosteroids. Eczema was defined by an algorithm developed from cases of clinically verified eczema. All children were followed to age 5 years in a cohort study design.

Results

The Copenhagen Prospective Study on Asthma in Childhood data showed increased risk of asthma exacerbation (hazard ratio 1.98 [95% CI 1.08-3.63]) if mothers had used antibiotics during third trimester. The Danish National Birth Cohort confirmed increased risk of asthma hospitalization (hazard ratio 1.17 [1.00-1.36]), and inhaled corticosteroids (1.18 [1.10-1.27]) in the children if mothers used antibiotics any time during pregnancy. In the subgroup of mothers using antibiotics for nonrespiratory infection, the children also had increased risk of asthma.

Conclusion

We found increased risk of asthma associated with maternal antibiotic use in a clinical study of a birth cohort with increased risk of asthma and replicated this finding in an unselected national birth cohort, and in a subgroup using antibiotics for nonrespiratory infections. This supports a role for bacterial ecology in pre- or perinatal life for the development of asthma.

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Keyword : COPSAC, DNBC, HR, ICS


Mappa


 The Copenhagen Prospective Study on Asthma in Childhood is funded by private and public research funds (available at www.copsac.com). Core support is provided by the Lundbeck Foundation, the Pharmacy Foundation of 1991, Augustinus Foundation, the Danish Medical Research Council, and the Danish Pediatric Asthma Center. The Danish National Birth Cohort was established, developed, and supported by the Danish National Research Foundation. Additional support was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation. The study was funded by the Health Foundation and Augustinus Foundation. The funding agencies did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest.


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