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Maternal and Early-Life Exposure to Antibiotics and the Risk of Autism and Attention-Deficit Hyperactivity Disorder in Childhood: a Swedish Population-Based Cohort Study

Author

Listed:
  • Lembris L. Njotto

    (Hasselt University
    College of Business Education (CBE))

  • Johanna Simin

    (Centre for Translational Microbiome Research (CTMR), Karolinska Institutet)

  • Romina Fornes

    (Centre for Translational Microbiome Research (CTMR), Karolinska Institutet)

  • Ingvild Odsbu

    (The Norwegian Institute of Public Health)

  • Isabelle Mussche

    (Centre for Ambulatory Revalidation (CAR) Ascendre)

  • Steven Callens

    (Ghent University Hospital
    Antwerp University
    Ghent University)

  • Lars Engstrand

    (Centre for Translational Microbiome Research (CTMR), Karolinska Institutet)

  • Robin Bruyndonckx

    (Hasselt University
    University of Antwerp)

  • Nele Brusselaers

    (Centre for Translational Microbiome Research (CTMR), Karolinska Institutet
    Antwerp University
    Ghent University)

Abstract

Introduction Antibiotics represent the most common type of medication used during pregnancy and infancy. Antibiotics have been proposed as a possible factor in changes in microbiota composition, which may play a role in the aetiology of autism and attention deficit/hyperactivity disorder (ADHD). Our aim was to investigate the association between maternal and early-life antibiotic use and autism and ADHD in childhood. Methods This Swedish nation-wide population-based cohort study included all first live singleton births (N = 483,459) between January 2006 and December 2016. The association of dispensed antibiotics with autism and ADHD in children aged ≤ 11 years was estimated by applying multivariable logistic regression and generalised estimating equations models. Results Of the mothers, 25.9% (n = 125,106) were dispensed ≥1 antibiotic during the exposure period (from 3 months pre-conception to delivery), and 41.6% (n = 201,040) of the children received ≥ 1 antibiotic in early life (aged ≤ 2 years). Penicillin was the most prescribed antibiotic class (17.9% of mothers, 38.2% of children). Maternal antibiotic use was associated with an increased risk of autism [odds ratio (OR) = 1.16, 95% confidence interval (CI) 1.09–1.23] and ADHD (OR = 1.29, 95% CI 1.21–1.36) in childhood. Early-life exposure to antibiotics showed an even stronger association [autism (OR = 1.46, 95% CI 1.38–1.55); ADHD (OR = 1.90, 95% CI 1.80–2.00)]. Both maternal and childhood-exposure sub-analyses suggested a dose-response relationship. Conclusion Maternal and early-life antibiotic use was associated with an increased risk of autism and ADHD in childhood. However, differences were noted by exposure period and antibiotic classes.

Suggested Citation

  • Lembris L. Njotto & Johanna Simin & Romina Fornes & Ingvild Odsbu & Isabelle Mussche & Steven Callens & Lars Engstrand & Robin Bruyndonckx & Nele Brusselaers, 2023. "Maternal and Early-Life Exposure to Antibiotics and the Risk of Autism and Attention-Deficit Hyperactivity Disorder in Childhood: a Swedish Population-Based Cohort Study," Drug Safety, Springer, vol. 46(5), pages 467-478, May.
    • Handle: RePEc:spr:drugsa:v:46:y:2023:i:5:d:10.1007_s40264-023-01297-1
    DOI: 10.1007/s40264-023-01297-1
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    Cited by:

    1. Rayane M. Botelho & Ana Lúcia M. Silva & Alexandre U. Borbely, 2024. "The Autism Spectrum Disorder and Its Possible Origins in Pregnancy," IJERPH, MDPI, vol. 21(3), pages 1-22, February.
    2. Rita Avó-Baião & Raquel Vareda & Andreia Lopes, 2024. "Comment on: “Maternal and Early-Life Exposure to Antibiotics and the Risk of Autism and Attention-Deficit Hyperactivity Disorder in Childhood: A Swedish Population-Based Cohort Study”," Drug Safety, Springer, vol. 47(8), pages 821-822, August.

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