Prenatal, Postnatal Antibiotic Exposure and AD in Children

eczema or atopic dermatitis on foot of a baby or infant
atopic dermatitis newborn feet eczema
A link between pre- and postnatal exposure to antibiotics and the risk for atopic dermatitis is investigated.

Children exposed to antibiotics during the prenatal as well as early postnatal periods may be at an increased risk for atopic dermatitis (AD), study data published in JAMA Network Open suggests.

This study used data for mother-child pairs obtained from the Swedish Medical Birth register. The register data were linked to other national registers to gain information on health, demographic, and socioeconomic data. Participants in the study were followed until they received a diagnosis of AD, or until emigration, death, or the end of the study occurred. The investigators estimated the risk for AD diagnosis in association with maternal exposure to systemic antibiotics during pregnancy and the child’s exposure to systemic antibiotics during the first year of life.

The mean age among the 722,767 singleton children was 5.8 years. Approximately 21.2% of the overall cohort was exposed to antibiotics in utero, and another 23.8% of children were exposed to antibiotics during their first year of life.

Children exposed to antibiotics during the prenatal period had a significantly higher risk for AD compared with children not exposed during this time (adjusted hazard ratio [aHR], 1.10; 95% CI, 1.09-1.12). There was no similar association observed in a sibling-control analysis (aHR, 0.96; 95% CI; 0.92-1.00).

In addition, children who are exposed to antibiotics during their first year of life also had a higher risk for AD (aHR, 1.52; 95% CI, 1.50-1.55). An attenuated association was found in a sibling-control analysis (aHR, 1.24; 95% CI, 1.20-1.29).

The investigators performed an additional multivariable-adjusted analysis that used the type of infection for which antibiotics were prescribed during the child’s first year of life as the exposure variable. In this analysis, the researchers found an increased risk for AD across respiratory (aHR, 1.45; 95% CI, 1.43-1.47), urinary tract (aHR, 1.33; 95% CI, 1.25-1.42), and skin or soft-tissue (aHR, 2.93; 95% CI, 2.81-3.06) infections.

According to the investigators, a limitation of this study included the possibility of residual confounding, primarily due to factors not shared by the siblings in the study.

The researchers concluded that additional research is needed to identify “the underlying mechanisms and the atopic dermatitis phenotypes that are more likely to be associated with other conditions, such as asthma and allergic rhinitis.”


Mubanga M, Lundholm C, D’Onofrio BM, Stratmann M, Hedman A, Almqvist C. Association of early life exposure to antibiotics with risk of atopic dermatitis in Sweden. JAMA Netw Open. 2021;4(4):e215245. doi:10.1001/jamanetworkopen.2021.5245