Association Between in Utero or Early-Life Exposure to Antibiotics and the Risk of Childhood Atopic Dermatitis

TAKE-HOME MESSAGE

• This population-based cohort study examined the association between antibiotic exposure in utero or very early in life and the relative risk of onset of atopic dermatitis (AD). In utero or early-life antibiotic exposure was associated with an increased risk of AD in children, with penicillin having the strongest association. The hazard ratios were higher in children born to mothers without AD, suggesting an effect modification by maternal AD status.
• There may be an association between AD and antibiotic exposure during pregnancy and early life; however, further research is needed to prove causation.

–  Rob Quiring, MD

Abstract

BACKGROUND

Atopic dermatitis (AD) is a common inflammatory disease of the skin that begins early in life and can be lifelong. The purpose of our study was to evaluate whether fetal exposure and/or early life exposure of a child to antibiotics increases the risk of early onset AD.

OBJECTIVE

We hypothesize that antibiotic exposure in utero or early in life (e.g., first 90 days) increases the likelihood that children develop AD.

METHODS

Utilizing a large prospectively collected electronic medical records database, we studied the association of antibiotic exposure received in utero or very early in life and the relative risk of onset of AD in a population-based cohort study. Associations were estimated using proportional hazards models as hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

The risk of AD in childhood was increased after in utero or early life antibiotic exposure. For any in utero AB exposure the HR was 1.38 (1.36,1.39). However, penicillin demonstrated the strongest association with AD for both in utero exposure, 1.43 (1.41,1.44), and for childhood exposure, 1.81(1.79,1.82). HRs were higher in children born to mothers without AD than those with AD pointing to effect modification by maternal AD status.

CONCLUSION

Children born to mothers exposed to antibiotics while in utero had, depending on the mother's history of AD, approximately a 20 to 40% increased risk of developing AD. Depending on the antibiotic, children who received antibiotics early-in-life had a 40 to 80% increased risk of developing AD. Our study, supports and refines the association between incident AD and antibiotic administration. It also adds population-based support to therapeutic attempts to treat AD by modifying skin microbiome.

The British Journal of Dermatology

In utero or early in life exposure to antibiotics and the risk of childhood atopic dermatitis, a population-based cohort study

Br J Dermatol 2023 Oct 28;[EPub Ahead of Print], Z Chiesa Fuxench, N Mitra, D Del Pozo, O Hoffstad, DB Shin, SM Langan, I Petersen, K Bhate, DJ Margolis

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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