Association Between In-Utero Exposure to Antibiotics and Offspring's Hearing Loss: A Systematic Review and Meta-Analysis.

Objectives: Antibiotic exposure during pregnancy is common, accounting for over 80% of all medications prescribed. Antibiotics in pregnancy are linked to increased childhood disease risk, through direct toxicity or potentially microbiome dysbiosis. This systematic review investigated the relationship between in-utero exposure to antibiotics and childhood hearing loss. Methods: We searched Ovid Medline, Embase, and PubMed for studies examining antibiotic exposure during pregnancy and its associations with hearing loss in offspring. Studies with children whose mothers had data on antibiotic exposure during pregnancy were selected. The meta-analysis calculated (1) pooled prevalence of childhood hearing loss and (2) pooled odds ratios (ORs) for associations between in-utero exposure to antibiotics and childhood hearing loss. Results: Of 1244 studies identified, 18 met the inclusion criteria. Among 161,053 children exposed in-utero to antibiotics, 4368 developed hearing loss. The pooled prevalence of childhood hearing loss was 0.9% (95% CI 0.0-2.8%, I² = 99.6%). In-utero exposure to antibiotics was associated with an increased risk of childhood hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 15.4%). Aminoglycoside exposure during pregnancy was associated with a higher risk of hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 38.4%), while exposure to other antibiotic classes showed no association. Conclusions: The prevalence of childhood hearing loss among those exposed to antibiotics during pregnancy is high. Although the overall risk appears modest, aminoglycosides are linked to a significantly higher risk, suggesting maternal aminoglycoside exposure may indicate a risk for child hearing loss. Further research is needed to clarify causal pathways and long-term effects of in-utero exposure to antibiotics.