Antibiotic Use in Pregnancy Associated with Increased Childhood Infection Risk: BMJ

A recent study published in the journal of BMJ Thorax revealed that maternal antibiotic use during pregnancy may increase the risk of infections in offspring during childhood, particularly those affecting the ear, nose, and throat.

Following rigorous Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study reviewed data from 14 cohort studies, encompassing more than 5 million children worldwide. Their systematic review and meta-analysis synthesized all available evidence on whether prenatal exposure to antibiotics influences the susceptibility of a child to infections later in life.

This research combed through medical databases including PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library, without restrictions on publication dates. Eligible studies were those that reported quantitative data linking maternal antibiotic use during pregnancy to infections in children beyond the newborn period.

The meta-analysis revealed a statistically significant association between prenatal antibiotic exposure and increased infection risk in children. When data from 12 of the 14 studies (covering nearly 5 million children) were combined, the odds of developing any infection during childhood were 33% higher in those exposed to antibiotics in the womb (OR 1.33, 95% CI 1.01–1.76, p=0.04).

The sensitivity analysis focused on high-quality studies, where the link grew even stronger, which showed a 48% increased risk (OR 1.48, 95% CI 1.13–1.95, p<0.01). The most pronounced rise was observed in ear, nose, and throat infections, affecting over 2.8 million children, where exposure during pregnancy corresponded to a 40% higher risk (OR 1.40, 95% CI 1.18–1.65, p<0.0001).

These results highlighted key features of each included study like the population size, antibiotic types, timing of exposure during pregnancy, and categories of infections assessed. Most studies showed low risk of bias and consistent findings across different populations.

Using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the certainty of evidence was rated high, reinforcing confidence in the overall conclusion. Overall, this research emphasized that while antibiotics remain crucial for managing infections during pregnancy, the findings illuminate the need for careful prescribing practices.

Source:

Alon, K., Hauerslev, M., Chawes, B. L. K., & Brustad, N. (2025). Maternal antibiotic use during pregnancy increases the risk of offspring airway infections: a systematic review and meta-analysis. Thorax. https://doi.org/10.1136/thorax-2025-223634