Paediatric and perinatal epidemiology · 2026
Joint Effects of Prenatal Antibiotics, Mode of Birth and Breastfeeding Duration on Childhood Infections: The Norwegian MoBa Cohort Study.
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Todd Isobel M F, Pedersen Lars Henning, Miller Jessica E, Burgner David P, Magnus Maria C
Аннотация
BACKGROUND: Prenatal antibiotic exposure and caesarean births are associated with an increased risk of hospitalised infection in children, but few studies have evaluated their impact on less severe infections and possible joint effects. Conversely, longer breastfeeding duration is protective against infections, but whether this effect varies according to previous perinatal exposures has not been explored. These three exposures are all hypothesised to influence the infant microbiome.
OBJECTIVES: To examine the individual and joint effects of prenatal antibiotic exposure, caesarean birth, and breastfeeding duration for both the incidence of infections and for hospitalisation for infection up to age three.
METHODS: Participants were from the Norwegian Mother, Father, and Child Cohort Study (MoBa). The three exposures were prenatal antibiotic exposure, caesarean birth, and breastfeeding duration. Using quasi-Poisson regression, we analysed the number of infections and hospitalisation for infections according to: (1) each exposure individually, (2) combined exposure to prenatal antibiotics and caesarean birth and (3) breastfeeding duration across the strata of prenatal antibiotics and birth mode.
RESULTS: Among 45,485 children followed from birth to age three, there was weak evidence for an increased number of infections according to the exposures of interest (incidence rate ratio for prenatal antibiotics 1.04, 95% CI 1.02, 1.05; caesarean birth 1.02, 95% CI 1.00, 1.03; breastfeeding < 6 months 1.04, 95% CI 1.02, 1.05), while there was an increased risk of hospitalised infection (risk ratio for prenatal antibiotics 1.11, 95% CI 1.05, 1.17; caesarean birth 1.20, 95% CI 1.14, 1.27; breastfeeding < 6 months 1.16, 95% CI 1.10, 1.22). Analyses of combined effects showed a 1.55-fold (95% CI 1.24, 1.93) increased risk of hospitalisation for infection with all three exposures compared to none.
CONCLUSIONS: Prenatal antibiotic exposure, caesarean birth and shorter breastfeeding duration were each associated with an increased risk of hospitalisation for infection in early childhood, with higher magnitude when multiple exposures occurred.
OBJECTIVES: To examine the individual and joint effects of prenatal antibiotic exposure, caesarean birth, and breastfeeding duration for both the incidence of infections and for hospitalisation for infection up to age three.
METHODS: Participants were from the Norwegian Mother, Father, and Child Cohort Study (MoBa). The three exposures were prenatal antibiotic exposure, caesarean birth, and breastfeeding duration. Using quasi-Poisson regression, we analysed the number of infections and hospitalisation for infections according to: (1) each exposure individually, (2) combined exposure to prenatal antibiotics and caesarean birth and (3) breastfeeding duration across the strata of prenatal antibiotics and birth mode.
RESULTS: Among 45,485 children followed from birth to age three, there was weak evidence for an increased number of infections according to the exposures of interest (incidence rate ratio for prenatal antibiotics 1.04, 95% CI 1.02, 1.05; caesarean birth 1.02, 95% CI 1.00, 1.03; breastfeeding < 6 months 1.04, 95% CI 1.02, 1.05), while there was an increased risk of hospitalised infection (risk ratio for prenatal antibiotics 1.11, 95% CI 1.05, 1.17; caesarean birth 1.20, 95% CI 1.14, 1.27; breastfeeding < 6 months 1.16, 95% CI 1.10, 1.22). Analyses of combined effects showed a 1.55-fold (95% CI 1.24, 1.93) increased risk of hospitalisation for infection with all three exposures compared to none.
CONCLUSIONS: Prenatal antibiotic exposure, caesarean birth and shorter breastfeeding duration were each associated with an increased risk of hospitalisation for infection in early childhood, with higher magnitude when multiple exposures occurred.