Antibiotic use and risk of autism spectrum disorder and attention-deficit/hyperactivity disorder: a population-based cohort study.

IF 3.4 3区医学 Q1 PEDIATRICS

Child and Adolescent Psychiatry and Mental Health Pub Date : 2024-07-11 DOI:10.1186/s13034-024-00774-4

Kai-Lin Yang, Ting-An Yen, Fang-Ju Lin, Chien-Ning Hsu, Chi-Chuan Wang

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引用次数: 0

Abstract

Background: The gut microbiota is believed to influence neurodevelopment through the gut-brain axis, but prior studies have shown inconsistent results regarding early childhood antibiotic exposure and subsequent risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The purpose of this study was to evaluate the hypothesis that exposure to antibacterial agents in the first 2 years of life increases the risk of ASD and/or ADHD.

Methods: This was a retrospective cohort study using 2003-2019 data from the National Health Insurance Research Database in Taiwan. Livebirths born between 2004 and 2016 were identified and separated into singleton, full sibling, and exposure-discordant sibling pair cohorts. The exposure group included children who filled at least one prescription for antibacterial agents between 0 and 2 years old in outpatient settings. The outcome, ASD and/or ADHD, was defined by at least one inpatient or outpatient diagnosis. The maximum follow-up age was 15 years in this study. Potential neonatal, maternal and paternal confounders were adjusted for. Cox proportional hazards models were used to estimate the relative event risk.

Results: The final sample contained 946,581 children in the singleton cohort, 1,142,693 children in the full sibling cohort, and 352,612 children in the exposure-discordant sibling pair cohort. Antibiotic exposure marginally increased the risk of ASD and/or ADHD in the singleton cohort (adjusted hazard ratio [aHR]: 1.06, 95% confidence interval [CI]: 1.04-1.07) and in the full sibling cohort (aHR: 1.03, 95% CI: 1.01-1.04). A slight decrease in the risk of ASD and/or ADHD was observed in the exposure-discordant sibling pair cohort (aHR: 0.92, 95% CI: 0.90-0.94).

Conclusions: The results suggest that early life antibiotic exposure has minimal impact on the risk of ASD and/or ADHD. Given that the estimated effects are marginal and close to null, concerns about ASD and/or ADHD risk increase should not postpone or deter timely and reasonable antibiotic use.

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使用抗生素与自闭症谱系障碍和注意力缺陷/多动症的风险：一项基于人群的队列研究。

背景：肠道微生物群被认为会通过肠道-大脑轴影响神经系统的发育，但之前的研究显示，儿童早期接触抗生素与随后出现自闭症谱系障碍（ASD）和注意力缺陷/多动症（ADHD）的风险之间存在不一致的结果。本研究的目的是对以下假设进行评估：出生后头两年接触抗菌剂会增加自闭症谱系障碍和/或多动症的风险：本研究是一项回顾性队列研究，使用的是台湾国民健康保险研究数据库中 2003-2019 年的数据。研究人员对 2004 年至 2016 年间出生的活产婴儿进行了鉴定，并将其分为单胎、全同胞和暴露-不一致同胞配对队列。暴露组包括0至2岁期间在门诊至少开过一次抗菌药处方的儿童。结果，即 ASD 和/或 ADHD，由至少一次住院或门诊诊断确定。本研究的最大随访年龄为 15 岁。对潜在的新生儿、母亲和父亲混杂因素进行了调整。采用 Cox 比例危险模型估算相对事件风险：最终样本包括单胎队列中的 946,581 名儿童、全同胞队列中的 1,142,693 名儿童以及暴露不一致的同胞配对队列中的 352,612 名儿童。在单胎队列（调整后危险比 [aHR]：1.06，95% 置信区间 [CI]：1.04-1.07）和同胞全队列（aHR：1.03，95% 置信区间 [CI]：1.01-1.04）中，抗生素暴露略微增加了 ASD 和/或多动症的风险。在接触不一致的同胞兄弟姐妹队列中，观察到ASD和/或ADHD的风险略有降低（aHR：0.92，95% CI：0.90-0.94）：结果表明，生命早期接触抗生素对罹患 ASD 和/或 ADHD 的风险影响极小。鉴于估计的影响微乎其微且接近于零，因此对 ASD 和/或 ADHD 风险增加的担忧不应推迟或阻止及时合理地使用抗生素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Child and Adolescent Psychiatry and Mental Health PEDIATRICSPSYCHIATRY-PSYCHIATRY

CiteScore

7.00

自引率

3.60%

发文量

审稿时长

16 weeks

期刊介绍： Child and Adolescent Psychiatry and Mental Health, the official journal of the International Association for Child and Adolescent Psychiatry and Allied Professions, is an open access, online journal that provides an international platform for rapid and comprehensive scientific communication on child and adolescent mental health across different cultural backgrounds. CAPMH serves as a scientifically rigorous and broadly open forum for both interdisciplinary and cross-cultural exchange of research information, involving psychiatrists, paediatricians, psychologists, neuroscientists, and allied disciplines. The journal focusses on improving the knowledge base for the diagnosis, prognosis and treatment of mental health conditions in children and adolescents, and aims to integrate basic science, clinical research and the practical implementation of research findings. In addition, aspects which are still underrepresented in the traditional journals such as neurobiology and neuropsychology of psychiatric disorders in childhood and adolescence are considered.