A large nationwide study has found that antibiotics given during pregnancy or in the first six months of life do not increase children’s risk of autoimmune diseases, offering reassurance for families and clinicians alike.
Published in PLoS Medicine, the research examined whether systemic antibiotic exposure affects the likelihood of developing conditions such as type 1 diabetes, juvenile idiopathic arthritis, inflammatory bowel disease, and autoimmune thyroiditis.
Study Background
Antibiotics are commonly prescribed to pregnant women and infants to treat urinary and respiratory infections. While essential for preventing serious illness, concerns have persisted that early-life exposure could subtly alter immunity and raise autoimmune disease risk. Factors such as genetics, microbiome disruption, and social determinants complicate the question, while untreated infections themselves pose dangers.
Methods
Researchers analyzed data from the National Health Insurance Service–National Health Insurance Database (NHIS–NHID) in South Korea, creating two linked mother-child cohorts spanning births from 2009 to 2020. Both cohorts included only families with documented infections to reduce confounding by indication. Antibiotic exposure was defined as any systemic prescription from 30 days before the last menstrual period through delivery for pregnancy, and any prescription during the first six months of life for infancy.
The team accounted for maternal demographics, comorbidities, medications, healthcare utilization, obstetric factors, and infant characteristics. Statistical models, including Cox proportional hazards models and sibling-matched analyses, were used to estimate hazard ratios while controlling for confounding factors.
Findings
The pregnancy cohort included 1.5 million exposed and 1.2 million unexposed children, while the infancy cohort included 1.9 million exposed and 1.4 million unexposed. Median follow-up was over seven years.
After controlling for confounders, no significant associations were found between antibiotic exposure and autoimmune outcomes. For example, prenatal exposure yielded a hazard ratio of 1.14 (95% CI 0.96–1.35) for type 1 diabetes and 1.02 (95% CI 0.85–1.22) for juvenile idiopathic arthritis. Early-infancy exposure similarly showed no elevated risks.
Sibling-matched analyses, which account for shared genetic and environmental factors, confirmed these null results. While initial “crude” analyses suggested elevated risks, these disappeared once infections and confounding factors were considered.
Subgroup Signals
Some modest patterns emerged: prenatal exposure to broad-spectrum antibiotics, especially cephalosporins in the first or second trimester, was linked to a slight increase in Crohn’s disease risk. Among infants, males exposed to antibiotics in the first two months showed a marginally higher risk of autoimmune thyroiditis. Sensitivity analyses broadly supported the main findings.
Implications
The study provides reassurance that treating confirmed infections with antibiotics during pregnancy or early infancy is generally safe regarding long-term autoimmune risk. Clinicians are advised to prescribe judiciously, monitor subgroups flagged in secondary analyses, and avoid unnecessary antibiotic courses.
Conclusion
This robust population-based study strengthens confidence that antibiotics, when appropriately prescribed in early life, do not substantially raise autoimmune disease risk in children. Signals for Crohn’s disease and autoimmune thyroiditis merit ongoing surveillance but do not undermine the overall safety of medically indicated antibiotic treatment.
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