Early-life exposure to antibiotics and excess body weight in childhood and adolescence: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 37573229 · doi:10.1016/j.orcp.2023.07.001
What was done
A systematic review and random-effects meta-analysis was conducted across PubMed, Web of Science, Scopus, and grey literature through August 10, 2022 (PROSPERO CRD42021265417). Two independent reviewers screened cohort studies investigating associations between antenatal or early postnatal antibiotic exposure and childhood or adolescent weight outcomes, extracted data, assessed risk of bias, and evaluated certainty of evidence.
What was found
From 42 included studies, data from 28 were quantitatively pooled: - Overall antenatal exposure: OR 1.10 (95% CI 1.04-1.16; 518,095 children; very low certainty). - Second trimester exposure: OR 1.11 (95% CI 1.08-1.14; 248,469 children; low certainty). - Early postnatal exposure: OR 1.09 (95% CI 1.05-1.12; 1,488,316 children; very low certainty). - Dose-response effect: OR 1.07 (95% CI 1.00-1.15; 512,954 children) for 1 course versus OR 1.31 (95% CI 1.17-1.46; 543,627 children) for 4 or more courses.
Why it matters
This review pools data across over 1.4 million children, demonstrating a dose-dependent statistical association between early antibiotic exposure and subsequent excess weight while emphasizing the need to account for unmeasured confounding.
Limits
The findings derive exclusively from observational cohort studies rated as having very low to low certainty of evidence. Residual confounding, indication bias (effects of underlying infections rather than the antibiotic itself), and heterogeneity across exposure definitions and weight measurement methods limit causal inference.
Cited by
- supports Early life exposure to antibiotics in mice and humans increases the risk of developing asthma and obesity later in life.