ECHO Research Finds No Significant Association Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Posted on by Jodi Snare

Wheezing symptoms occur in 20-40% of infants, contributing to a substantial impact on children’s quality of life and their use of healthcare. Multiple early exposures, such as prenatal exposure to cigarette smoking, have been associated with these wheezing symptoms. Previous studies have suggested a possible link between antibiotic exposure during pregnancy and an increased risk of wheezing and cough in children, caused by an imbalance in the birthing parent’s microbiome due to antibiotic use.

“It is unlikely that a randomized controlled trial could be done to try to answer this question, because antibiotics are necessary treatments for bacterial infections during pregnancy,” said ECHO Cohort investigator Rachel Greenberg, MD, MB, MHS of Duke University. “In the absence of trial data, large studies that observe individuals over time, like the ECHO Cohort, are essential to understand the impact of common interventions during pregnancy.”

This study included 4,721 pregnant participants and their 4,779 infants from 12 study sites in the ECHO Cohort Consortium. Overall, 36% of pregnant participants used at least one antibiotic while pregnant, and about 26% of infants had a report of wheezing.

Key takeaways include:

  • Exposure to antibiotics during pregnancy was not associated with infant wheezing during the first 18 months after birth.
  • Prenatal antibiotic exposure was also not associated with an increase in emergency room visits or hospitalizations for wheeze during infancy.
  • However, prenatal antibiotic use was associated with higher odds of medication use for wheeze or dry cough during infancy, which could imply more severe symptoms and a medical provider’s diagnosis.
  • An association between prenatal antibiotic exposure and medication use for wheeze or cough during infancy was only observed among children born via vaginal delivery and thus exposed to the birthing parent’s microbiota.
  • The researchers also observed an association between prenatal antibiotic exposure and wheeze in research sites that recruited participants who had a family history of asthma, suggesting that a genetic or environmental risk within these families may increase the likelihood of wheeze.

This collaborative research, titled “Association Between Prenatal Antibiotic Exposure and Infant Wheeze Outcomes” is published in Acta Paediatrica.