Background: Exposure to antibiotics is common during pregnancy and may cause disruptions of the gut microbiota and alter metabolic health of the host, accordingly, it has a significant impact on glucose homeostasis. However, the risk of disorders of glycemic control in offspring associated with the use of antibiotics during pregnancy has not been fully addressed.
Objectives: To investigate whether prenatal antibiotics use is associated with the risk of glycemic control events among child.
Methods: We conducted a nationwide cohort study using Korea’s National Health Insurance Service (NHIS) claims database; the mother-offspring cohort was constructed by the NHIS. We included all pregnancies gave live birth aged 15-50 years and their child between 2009-2021. We defined exposure as at least 1 record of antibiotics prescription during pregnancy, from start of the pregnancy to the day before delivery date. The outcomes of interest were type 1 diabetes mellitus (DM), type 2 DM and hypoglycemia in child for up to 13 years of age. The antibiotics-exposed pregnancies were compared to unexposed in propensity score (PS)-matched analyses to adjust potential imbalances for >50 covariates using Cox proportional hazard models. Further, sibling-matched analysis was conducted to minimize bias from within-family confounders for child outcomes.
Results: Among 2,527,541 mother-offspring pairs, we identified 686,224 PS-matched pairs among pregnancies with a mean (SD) age of 31.6 (4.3) years. For disorders of glycemic control in children, PS-matched HRs for the risk of type 1 DM, type 2 DM and hypoglycemia were 1.17 (95% confidence interval, 0.95-1.44), 1.14 (0.96-1.34) and 1.07 (1.01-1.14), respectively. In sibling-matched analyses, the HRs were consistent to those of PS-matched analyses, and only that of hypoglycemia was statistically significant [1.14 (1.00-1.29)]. Similar associations were found between disorders of glycemic control in child and antibiotics exposure when we restricted pregnancy with caesarean section or indications for antibiotics.
Conclusions: In this large, population-based study, we found antibiotics use during pregnancy was not associated increased risk of disorders of glycemic control in child. Nevertheless, the occurrence of hypoglycemia in infants was marginally elevated when exposed to antibiotics during pregnancy. Future studies are warranted to reassure this association, and health care providers should thoroughly weigh the benefits of antibiotics use in pregnant women with continued monitoring for any potential glycemic-related safety events in their children.
