The Association between Autism Spectrum Disorder and Pre- and Postnatal Antibiotic Exposure in Childhood—A Systematic Review with Meta-Analysis

Abstract

Autism spectrum disorder (ASD) is a developmental disorder that begins in early childhood and has been associated with several environmental and genetic factors. We aimed to conduct two-side meta-analyses to determine the association between ASD and pre- and postnatal antibiotic exposure in childhood. We searched PubMed, Embase, Web of Science, and Cochrane Library for articles published up to February 2019. We evaluated observational studies that assessed the association between ASD and antibiotic exposure. Of 1459 articles, nine studies were used in the meta-analysis. We found that early antibiotic exposure, including pre- and postnatal, significantly increased the ASD risk in children. Furthermore, early antibiotic exposure, including pre- and postnatal, was significantly increased in children with ASD. Specifically, prenatal antibiotic exposure was significantly increased in children with ASD; however, postnatal antibiotic exposure was not. Our results indicate an association between ASD and early antibiotic exposure; specifically, that prenatal antibiotic exposure is an important risk factor of ASD in children.

Assessment of Cesarean Delivery and Neurodevelopmental and Psychiatric Disorders in the Children of a Population-Based Swedish Birth Cohort

“…Second, the registers do not include information on other perinatal factors thought to have an effect on child microbiota development (eg, exposure to antibiotics during pregnancy and breastfeeding), 40 , 41 , 42 , 43 although the evidence of these effects is inconclusive. 16 , 19 , 44 , 45 , 46 , 47 , 48 , 49 Third, generalizability may be a concern, because the CD rate varies greatly between countries. 50 Our findings may only be generalizable to countries with similar settings where most CDs are performed in the presence of medical indications.…”

“…[40][41][42][43] although the evidence of these effects is inconclusive. 16,19,[44][45][46][47][48][49] Third, generalizability may be a concern, because the CD rate varies greatly between countries. 50 Our findings may only be generalizable to countries with similar settings where most CDs are performed in the presence of medical indications.…”

Intrathecal autologous bone marrow stem cell therapy in children with autism: A randomized controlled trial

“…We hypothesize that some unadjusted differences between the two study groups, namely exposure to antibiotics and anesthetics, might have affected our results. For instance, exposure to antibiotics particularly in the prenatal period has been associated with the risk of developing ASD in some studies (Lee, Cho, & Kim, 2019). Furthermore, exposure to anesthesia has been controversially linked to autism in the literature.…”

Microbiota and Microglia Interactions in ASD

“…However, mothers of children with ASD often present with compositional differences in their gut microbiota, including increased levels of Proteobacteria , Alphaproteobacteria , Moraxellaceae , and Acinetobacter , when compared to mothers of healthy, neurotypical children ( 121 ). Moreover, meta-analyses of large cohort studies suggest prenatal exposure to different classes of antibiotics could contribute to the development of ASD ( 122 , 123 ). However, data linking prenatal antibiotic exposure to ASD development in the offspring are highly controversial, and these studies neglect to evaluate the impact that antibiotic treatments have on the composition of the maternal microbiota during pregnancy.…”