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  • Clinical Research Article
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Associations of intrapartum antibiotics and growth, atopy, gastrointestinal and sleep outcomes at one year of age

Pediatric Research volume 94, pages 1026–1034 (2023)Cite this article

A Correction to this article was published on 09 June 2023

This article has been updated

Abstract

Background

Studies investigating neonatal outcomes following intrapartum antibiotic exposure show conflicting results.

Methods

Data were collected prospectively in pregnancy to 1-year-of-age, from 212 mother-infant pairs. Adjusted multivariable regression models estimated relationships following exposure to intrapartum antibiotics among vaginally-born, full-term infants and outcomes related to growth, atopic disease, gastrointestinal symptoms, and sleep at 1-year.

Results

Intrapartum antibiotic exposure (n = 40) was not associated with mass, ponderal index, BMI z-score (1- year), lean mass index (5-months) or height. Antibiotic exposure in labour ≥4-h was associated with increase in fat mass index at 5-months (β 0.42 [95% CI: 0.03, 0.80], p = 0.03). Intrapartum antibiotic was associated with atopy in the first year (OR: 2.93 [95% CI: 1.34, 6.43], p = 0.007). Antibiotic exposure during intrapartum or day 1–7 was associated with newborn fungal infection requiring antifungal therapy (OR 3.04 [95% CI: 1.14, 8.10], p = 0.026), and number of fungal infections (IRR: 2.90 [95% CI: 1.02, 8.27], p = 0.046).

Conclusion

Intrapartum and early life exposure to antibiotics were independently associated with measures of growth, atopy, and fungal infections suggesting that intrapartum and early neonatal antibiotics be used prudently following careful risk-benefit analysis.

Impact

This prospective study:

  • Shows a shift in fat mass index at 5 months associated with antibiotic administration ≥4 h in labour; an earlier age than previously reported;

  • Shows atopy reported less frequently among those not exposed to intrapartum antibiotics;

  • Supports earlier research of increased likelihood of fungal infection following exposure to intrapartum or early-life antibiotics;

  • Adds to growing evidence that antibiotics used intrapartum and in early neonatal periods influence longer-term outcomes for infants.

  • Suggests that use of intrapartum and early neonatal antibiotics should be used prudently after careful consideration of risk and benefit.

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Fig. 1: Flow diagram illustrating participants at each phase of the study.

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Data availability

Access to the data included in this manuscript is available through direct contact with the Corresponding Author.

Change history

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Acknowledgements

We would like to thank the parents and their babies who participated in this study for their valuable time. We gratefully acknowledge the midwives and administrators at The Hamilton Midwives, Community Midwives of Hamilton, Access Midwives, Burlington and Area Midwives, Community Midwives of Brantford, Lincoln Community Midwives, Niagara Midwives and Renaissance Midwifery for the time they committed to recruiting participants and collecting data. We would like to thank Laura Rossi and Michelle Shah for their work in processing the stool samples for analysis as well as Efrah Yousuf and Niels Rochow for computing the body composition imputations.

Funding

This study is funded by grants from the Hamilton Academic Health Sciences Organization and the Canadian Institutes of Health Research (MOP-136811).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada

    Eileen K. Hutton, Julia C. Simioni & Alison C. Holloway

  2. McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada

    Eileen K. Hutton, Julia C. Simioni & Helen McDonald

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Canada; Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada

    Lehana Thabane

  4. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Lehana Thabane, Elyanne M. Ratcliffe & Katherine M. Morrison

  5. Centre for Metabolism Obesity and Diabetes Research, Hamilton, ON, Canada

    Katherine M. Morrison

  6. Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada

    Elyanne M. Ratcliffe, Jonathan D. Schertzer, Jennifer C. Stearns & Mike G. Surette

  7. Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, ON, Canada

    Jonathan D. Schertzer & Mike G. Surette

  8. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Jennifer C. Stearns & Mike G. Surette

Authors
  1. Eileen K. Hutton
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  4. Katherine M. Morrison
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Consortia

the Baby & Mi Research Team

  • Alison C. Holloway
  • , Helen McDonald
  • , Elyanne M. Ratcliffe
  • , Jonathan D. Schertzer
  • , Jennifer C. Stearns
  •  & Mike G. Surette

Contributions

E.K.H., J.C.S., and K.M.M. had full access to all of the data. E.K.H., J.C.S., L.T., and K.M.M. conceptualised the study design. E.K.H., J.C.S., and K.M.M. were responsible for the investigation and conduct of this study. J.C.S. acquired the data and conducted the analysis with the methodological support from L.T., E.K.H. and K.M.M. E.K.H., J.C.S., and K.M.M. wrote the original draft of the manuscript and all authors revised and edited the manuscript for critical content and methodology. E.K.H., J.C.S., L.T., and K.M.M. contributed to funding acquisition.

Corresponding author

Correspondence to Katherine M. Morrison.

Ethics declarations

Competing interests

The authors declare no competing interests.

Informed consent

Written informed consent was provided by all participants prior to enrolment in the study.

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The original online version of this article was revised: firstly, the sentence “Antibiotic exposure in labour ≥4-h was associated with increase in fat mass index at 5-months (β 0.42 [95% CI: −0.03, 0.80], p = 0.03)” in the abstract was corrected to read “Antibiotic exposure in labour ≥4-h was associated with increase in fat mass index at 5-months (β 0.42 [95% CI: 0.03, 0.80], p = 0.03)”. In the ‘Results’ section, the sentence “However intrapartum exposure to antibiotic ≥4-h duration was independently associated with fat mass index at 5 months (β 0.342 [95% CI: 0.032, 0.80], p = 0.03) (Table 3)” was corrected to “However intrapartum exposure to antibiotic ≥4-h duration was independently associated with fat mass index at 5 months (β 0.42 [95% CI: 0.03, 0.80], p = 0.03) (Table 3)”. Finally in table 3, the data in the row ‘Fat mass index at 5 months’ and under the column ‘Sensitivity analysis: IAP ≥ 4 h exposure’ was corrected from “0.42 (−0.030, 0.80)” to “0.42 (0.03, 0.80)”.

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Hutton, E.K., Simioni, J.C., Thabane, L. et al. Associations of intrapartum antibiotics and growth, atopy, gastrointestinal and sleep outcomes at one year of age. Pediatr Res 94, 1026–1034 (2023). https://doi.org/10.1038/s41390-023-02525-1

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