TOPLINE

Maternal intrapartum antibiotic use was associated with an increased risks for infant allergen sensitization, immunoglobulin (Ig)E-mediated food allergy, and medically diagnosed atopic eczema. However, these associations were not observed in mothers who received prebiotic supplementation.

METHODOLOGY

• Researchers conducted an exploratory analysis of a randomized trial involving 568 mothers (median age, 32.4 years) with infants at familial risk for allergic disease in Australia between 2016 and 2021.
• Mothers were randomly assigned to consume daily prebiotics (galacto- and fructo-oligosaccharides) or a placebo (maltodextrin) powder from 18-20 weeks of gestation until 6 months of lactation.
• Data on maternal and infant antibiotic use was prospectively collected monthly. Exposures were categorized as antenatal, intrapartum (maternal antibiotics administered during labor or induction up to 1 hour before delivery), during cesarean section (within 1 hour of incision), during lactation (from birth to 6 months), and direct infant administration (from birth to 6 months of age).
• Infant allergic disease outcomes, including allergen sensitization, IgE-mediated food allergy, and medically diagnosed atopic eczema, were assessed at 1 year of age.

TAKEAWAY

• In mothers assigned to receive placebo, intrapartum antibiotics were associated with higher risks for allergen sensitization (adjusted relative risk [aRR], 3.56; P = .001), IgE-mediated food allergy (aRR, 5.67; P < .001), and medically diagnosed atopic eczema (aRR, 6.42; P < .001) in infants by 1 year of age.
• In contrast, in mothers randomly assigned to receive prebiotics, intrapartum antibiotic exposure was not associated with these outcomes in infants.
• Maternal and infant antibiotic use during the antenatal, cesarean section, and lactation phases and through direct infant administration was not significantly associated with any infant allergic disease outcomes.

IN PRACTICE

“Prebiotics may represent a potential strategy to mitigate downstream immune responses,” the authors wrote.

SOURCE

Debra J. Palmer, with the University of Western Australia, Perth, Australia, was the corresponding author of the study, which was published online on July 14 in Allergy.

LIMITATIONS

This study had small sample sizes in subgroup analyses, resulting in wide CIs; therefore, the interaction findings should be considered exploratory rather than definitive. Paired microbiome data were not collected, and some possible confounders were not measured. Moreover, because the cohort was mostly White, the findings may not be generalizable to all populations.

DISCLOSURES

This study was supported by the National Health and Medical Research Council and several other Australian funding bodies. One author was a part-time employee of Danone Nutricia and reported receiving research funding from multiple public and private sources, including several infant nutrition companies. Another author reported receiving speaker's fees from Danone Nutricia.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.