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Pediatrics

Maternal antibiotic use during pregnancy and childhood obesity at age 5 years

International Journal of Obesity volume 43, pages 1202–1209 (2019)Cite this article

Subjects

Abstract

Objective

The benefits of antibiotic treatment during pregnancy are immediate, but there may be long-term risks to the developing child. Prior studies show an association between early life antibiotics and obesity, but few have examined this risk during pregnancy.

Subjects

To evaluate the association of maternal antibiotic exposure during pregnancy on childhood BMI-z at 5 years, we conducted a retrospective cohort analysis. Using electronic health record data from seven health systems in PCORnet, a national distributed clinical research network, we included children with same-day height and weight measures who could be linked to mothers with vital measurements during pregnancy. The primary independent variable was maternal outpatient antibiotic prescriptions during pregnancy (any versus none). We examined dose response (number of antibiotic episodes), spectrum and class of antibiotics, and antibiotic episodes by trimester. The primary outcome was child age- and sex-specific BMI-z at age 5 years.

Results

The final sample was 53,320 mother–child pairs. During pregnancy, 29.9% of mothers received antibiotics. In adjusted models, maternal outpatient antibiotic prescriptions during pregnancy were not associated with child BMI-z at age 5 years (β = 0.00, 95% CI −0.03, 0.02). When evaluating timing during pregnancy, dose-response, spectrum and class of antibiotics, there were no associations of maternal antibiotics with child BMI-z at age 5 years.

Conclusion

In this large observational cohort, provision of antibiotics during pregnancy was not associated with childhood BMI-z at 5 years.

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Acknowledgements

All statements in this manuscript are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governor, or Methodology Committee. The PCORnet Childhood Antibiotic Study Team includes a diverse group of investigators, research staff, clinicians, community members, and parent caregivers. All members of the team including the study’s Executive Antibiotic Stakeholder Advisory Group (EASAG) contributed to the study design, data acquisition, and interpretation of results. The Study Team would like to thank the leaders of the participating PCORnet Clinical Data Research Networks (CDRNs), Patient Powered Research Networks (PPRNs), and PCORnet Coordinating Center as well as members of the PCORI team for their support and commitment to this project.

Members of the PCORnet Antibiotics and Childhood Growth Study Group:

David Arterburn12, Lauren P. Cleveland4, Jonathan Finkelstein13, Stephanie L. Fitzpatrick14, Andrea Goodman15, Michael Horberg16, Jenny Ingber17, Kathleen Murphy17, Holly Landrum Peay18, Pedro Rivera19, Juliane S. Reynolds6, Jessica L. Sturtevant6, Ivette Torres20

Funding

This work was supported through the Patient-Centered Outcomes Research Institute (PCORI) Program Award (OBS-1505-30699).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    William J. Heerman

  2. Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, 80014, USA

    Matthew F. Daley

  3. School of Public Health, Oregon Health and Science University/Portland State University, Portland, OR, USA

    Janne Boone-Heinonen

  4. Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA

    Sheryl L. Rifas-Shiman, Matthew W. Gillman, Chelsea Jenter, Jason P. Block & Lauren P. Cleveland

  5. Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    L. Charles Bailey & Christopher B. Forrest

  6. Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA

    Jessica G. Young, Casie E. Horgan, Sengwee Toh, Juliane S. Reynolds & Jessica L. Sturtevant

  7. Dr. Gillman is now Director of the Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA

    Matthew W. Gillman

  8. Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA

    David M. Janicke

  9. HealthPartners Institute, Department of Research, Bloomington, MN, USA

    Elyse O. Kharbanda

  10. North Fork School District, Utica, OH, USA

    Doug Lunsford

  11. Department of Pediatrics, New York University, Bellevue Hospital Center, New York, NY, USA

    Mary Jo Messito

  12. Washington Permanente Medical Group, Internal Medicine, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    David Arterburn

  13. Boston Children’s Hospital, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA

    Jonathan Finkelstein

  14. Center for Health Research, Kaiser Permanente North West, Portland, OR, USA

    Stephanie L. Fitzpatrick

  15. Genetic Alliance PCORnet Coordinating Center, Genetic Alliance, Washington, DC, USA

    Andrea Goodman

  16. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA

    Michael Horberg

  17. no affiliation, New York, NY, USA

    Jenny Ingber & Kathleen Murphy

  18. RTI International, Research Triangle Park, Triangle Park, NC, USA

    Holly Landrum Peay

  19. OCHIN Inc, Portland, OR, USA

    Pedro Rivera

  20. Clinical Research Department, Valley Baptist Medical Center - Harlingen, Harlingen, TX, USA

    Ivette Torres

Authors
  1. William J. Heerman
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  2. Matthew F. Daley
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  3. Janne Boone-Heinonen
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  4. Sheryl L. Rifas-Shiman
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  5. L. Charles Bailey
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  6. Christopher B. Forrest
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  7. Jessica G. Young
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  10. David M. Janicke
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  11. Chelsea Jenter
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  12. Elyse O. Kharbanda
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  13. Doug Lunsford
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  14. Mary Jo Messito
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  15. Sengwee Toh
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  16. Jason P. Block
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Consortia

On behalf of the PCORnet Antibiotics and Childhood Growth Study Group

  • David Arterburn
  • , Lauren P. Cleveland
  • , Jonathan Finkelstein
  • , Stephanie L. Fitzpatrick
  • , Andrea Goodman
  • , Michael Horberg
  • , Jenny Ingber
  • , Kathleen Murphy
  • , Holly Landrum Peay
  • , Pedro Rivera
  • , Juliane S. Reynolds
  • , Jessica L. Sturtevant
  •  & Ivette Torres

Corresponding author

Correspondence to William J. Heerman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

“The views expressed in this article do not necessarily represent the views of the US Government, the Department of Health and Human Services or the National Institutes of Health.”

List of members of the PCORnet Antibiotics and Childhood Growth Study Group is listed below Acknowledgement

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Heerman, W.J., Daley, M.F., Boone-Heinonen, J. et al. Maternal antibiotic use during pregnancy and childhood obesity at age 5 years. Int J Obes 43, 1202–1209 (2019). https://doi.org/10.1038/s41366-018-0316-6

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