International Journal of Epidemiology, 2018, 1 doi: 10.1093/ije/dyy096 Letter to the Editor Letter 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: email@example.com 1 4 The recently published study by Miller et al. reported that Using a similar Danish cohort, Stokholm et al. ob- antibiotic exposure before or during pregnancy was associ- served an association with maternal exposure to antibiotics ated with an increased risk of childhood infection-related 1.5 years after delivery, which could have minimal influ- hospitalizations. They attributed this risk to a complex in- ence on the vertical transmission of gut microbiota. With terplay of perturbed maternal microbiota, environmental the kind of registries used in the study, it would be signifi- factors and immunogenetics. Although genetics and envi- cant to examine the timing of postnatal maternal antibiot- ronmental factors are undeniably significant elements, the ics and compare it with the childhood postnatal antibiotic causative impact of maternal antibiotic exposure before exposure and hospitalization. There is a possibility that the and during pregnancy could be questioned. maternal infections and other critical postnatal influences, A consistent level of antibiotic usage before and during such as duration of breastfeeding (given the role of immu- pregnancy is a significant indication of increased susceptibility noglobulins), might play a more significant role than dys- to infection. The results of the study indicated no significant biosis in childhood infections. difference in the risk of hospitalization in children whose References mothers had antibiotics either before or during pregnancy 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- tion with infection in offspring: a population-based cohort study. cumulative antibiotic exposure before and during pregnancy, 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-Munoz ~ ME, Arrieta MC, Ramer-Tait AE, Walter J. A criti- infection-related hospitalization. Although the presence of a cal assessment of the “sterile womb” and “in utero colonization” hypotheses: implications for research on the pioneer infant micro- dose-response relationship has been pointed to as evidence of 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. Breastfeeding and health outcomes for the mother-infant dyad. risk observed with caesarean section delivery is debatable un- Pediatr Clin North Am 2013;60:31–48. less for a plausible horizontal transfer during breastfeeding. V The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association 1 Downloaded from https://academic.oup.com/ije/advance-article-abstract/doi/10.1093/ije/dyy096/5026408 by Ed 'DeepDyve' Gillespie user on 12 July 2018
International Journal of Epidemiology – Oxford University Press
Published: May 31, 2018
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