Downloaded from https://academic.oup.com/ije/article-abstract/47/5/1723/5026408 by Ed 'DeepDyve' Gillespie user on 07 November 2018 International Journal of Epidemiology, 2018, 1723 doi: 10.1093/ije/dyy096 Advance Access Publication Date: 31 May 2018 Letters to the Editor Letters to the Editor Maternal antibiotic exposure during pregnancy and hospitalization with infection in offspring 1,2 1,2 1,2,3 Abin Chandrakumar, Aseem Bhardwaj and Geert W ‘t Jong * 1 2 Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada, Clinical Research Unit, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada and Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada *Corresponding author. E-mail: firstname.lastname@example.org 1 4 The recently published study by Miller et al. reported that Using a similar Danish cohort, Stokholm et al. antibiotic exposure before or during pregnancy was associ- observed an association with maternal exposure to antibi- ated with an increased risk of childhood infection-related otics 1.5 years after delivery, which could have minimal hospitalizations. They attributed this risk to a complex influence on the vertical transmission of gut microbiota. interplay of perturbed maternal microbiota, environmental With the kind of registries used in the study, it would be factors and immunogenetics. Although genetics and envi- significant to examine the timing of postnatal maternal ronmental factors are undeniably significant elements, the antibiotics and compare it with the childhood postnatal causative impact of maternal antibiotic exposure before antibiotic exposure and hospitalization. There is a possibil- and during pregnancy could be questioned. ity that the maternal infections and other critical postnatal A consistent level of antibiotic usage before and during influences, such as duration of breastfeeding (given the role pregnancy is a significant indication of increased susceptibility of immunoglobulins), might play a more significant role to infection. The results of the study indicated no significant than dysbiosis in childhood infections. difference in the risk of hospitalization in children whose mothers had antibiotics either before or during pregnancy References only. The risk of childhood infection-related hospitalization 1. Miller JE, Wu C, Pedersen LH, de Klerk N, Olsen J, Burgner DP. was more significant in vaginally born infants when there was Maternal antibiotic exposure during pregnancy and hospitaliza- cumulative antibiotic exposure before and during pregnancy, tion with infection in offspring: a population-based cohort study. Int J Epidemiol 2018;47:561–71. again indicating an increased maternal susceptibility to infec- 2. Azad MB, Konya T, Maughan H et al. Gut microbiota of healthy tion. Caesarean section delivery, which is an established Canadian infants: proﬁles by mode of delivery and infant diet at 4 dysbiosis-inducing factor, should have increased the risk if it months. CMAJ 2013;185:385–94. was the antibiotic-induced dysbiosis that was precipitating 3. Perez-Mun ˜ oz ME, Arrieta MC, Ramer-Tait AE, Walter J. A crit- infection-related hospitalization. Although the presence of a ical assessment of the “sterile womb” and “in utero colonization” dose-response relationship has been pointed to as evidence of hypotheses: implications for research on the pioneer infant micro- biome. Microbiome 2017;5:48. causality, the increased number of antibiotic courses is a clear 4. Stokholm J, Sevelsted A, Bønnelykke K, Bisgaard H. Maternal indication of increased maternal susceptibility (if not of propensity for infections and risk of childhood asthma: a registry- health-seeking behaviour). With more evidence to support based cohort study. Lancet Respir Med 2014;2:631–37. than disprove the sterile womb hypothesis, the cumulative 5. Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breast- risk observed with caesarean section delivery is debatable feeding and health outcomes for the mother-infant dyad. Pediatr unless for a plausible horizontal transfer during breastfeeding. Clin North Am 2013;60:31–48. V The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association 1723
International Journal of Epidemiology – Oxford University Press
Published: Oct 1, 2018
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