Intrapartum antibiotic exposure for group B streptococcus prevention and body mass index trajectory in a population-based cohort of California children

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Koebnick, Corinna ; Sidell, Margo A ; Getahun, Darios ; Tartof, Sara Y ; Rozema, Emily ; Xiang, Anny H ; Spiller, Michael W ; Sharma, Andrea J ; Mukhopadhyay, Sagori ; Puopolo, Karen M ; Schrag, Stephanie J
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• Description:
  Importance: ; Intrapartum antibiotics greatly reduce a newborn’s risk of group B streptococcal infection (GBS) but may increase the risk of obesity during childhood due to disruption of microbiome formation. ; Objective: ; To examine the association between GBS intrapartum antibiotics and body mass index (BMI) trajectory during the first 5 years after birth. ; Design, Setting, and Participants: ; Retrospective cohort study in an integrated health care system in Southern California of 223,431 singleton-birth infants with >12 months of follow-up between 2007 and 2015. ; Exposure: ; We compared children exposed to GBS intrapartum antibiotic prophylaxis (IAP) defined as administration of penicillin G, ampicillin, cefazolin, clindamycin or vancomycin ≥4 hours before delivery to those unexposed or exposed to any other type or duration of antibiotics within 48 hours before delivery. Reference for vaginal delivery were unexposed children. Because virtually all children born by Cesarean delivery are exposed, other antibiotics were used as reference. ; Main Outcome and Measure: ; BMI measured during routine visits between 0 and 5 years of age was compared between exposure groups using non-linear multivariable models with B-spline functions (knots 0.4, 1.2, and 2.7 years of age), stratified by delivery mode (vaginal or Cesarean), and adjusted for demographic, maternal and birth-related factors, breastfeeding and childhood antibiotic exposure. ; Results: ; The mean follow-up time was 4.94 (SD 2.71) years (1,103,569 person-years) with 13.4 (SD 5.3) BMI measures per child; 20.0% (31,263/156,381) of vaginal and 12.5% (8,366/67,050) of Cesarean deliveries were exposed to GBS IAP. In vaginally delivered infants, GBS IAP, but not other intrapartum antibiotics, were associated with increased BMI at age 5 (0.12 kg/m2, 95% CI 0.07 to 0.16 kg/m2, P<0.001), compared to no antibiotics. In Cesarean deliveries, GBS IAP was associated with increased BMI at age 5 (0.24 kg/m2, 95% CI 0.14 to 0.34 kg/m2, P<0.001) compared to other antibiotics. Breastfeeding did not modify these associations. ; Conclusions and Relevance: ; With GBS IAP used in 1 in 3 U. S. births, the potential increase in BMI on a population level, although small, is relevant. While this does not support changing current practice, it is important to also pursue preventive strategies such as maternal GBS immunization.
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• Subjects:
  • Anti-Bacterial Agents
  • Antibiotic Prophylaxis
  • Body Mass Index
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
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• Keywords:
  • Perinatal group B streptococcus disease
  • intrapartum antibiotic prophylaxis
  • childhood obesity
  • body mass index
• Source:
  Clin Infect Dis. 73(4):e938-e946
• Pubmed ID:
  33493270
• Pubmed Central ID:
  PMC11309029
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; HCVLD-2017-16907/CC/CDC HHSUnited States/
• Volume:
  73
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/159777/cdc_159777_DS1.pdf
• File Type:
  [PDF - 635.15 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:fc011c3b81b8d38d309bc4d52f90a3208212318ebebe95dcda2661ceaa79c51304b286cd7ea4617f1b18bf9532518bfba286a155f9e554c35ea6dd6a69398b22