Study Points to More Reasons to Avoid Inappropriate Antibiotic Use

In a post entitled, ‘Can Mothers Alter Their Children’s Risk for Developing Celiac Disease?’  Dr Bud Wiedermann, MD, MA,  raises new interesting questions about antibiotic use. 

  • presented at Grand Rounds, American Academy of Pediatrics

 antibiotics overuse risk factor celiac diseaseDr. Wiedermann’s short answer to that question is a qualified “no,” based on a study of 1,912,204 births over a 19-year period and with 6596 children ultimately diagnosed with celiac disease. (1) Link to study below

“This study, centered in Sweden and taking advantage of a well-oiled national health care system, had an enormous sample size. With the use of multivariate logistic regression analysis, it was determined:”

  • Regardless of sex, a reduction in CD risk was observed in children born to mothers aged ≥35 years and with high maternal income
  • Being a second-born child, however, was positively associated with CD.
  • Among boys
    • elective caesarean delivery increased the risk of CD
    • maternal overweight, premature rupture of the membrane and low birth weight showed a negative association.
  • Girls
    • had an increased CD risk compared to boys and
    • in girls the risk was increased by repeated maternal urinary tract infections.

“Does any of this make sense with what we know about celiac disease?”

Dr. Wiedermann suggested that, “the best biologically plausible answer lies in a possible relationship of intestinal microflora (the gut microbiome) and immune system development. If some of these associated maternal factors led to differences in antibiotic use, it might explain how they could alter the risk of celiac disease development.”

“What should clinicians do with this information?”

“Putting this into the context of primary care practice as a whole, the study points to yet another reason to avoid inappropriate antibiotic use,” says Dr. Wiedermann

“Let’s all try to limit antibiotic use to situations where a child (and mother) truly benefit from treatment, in particular trying to avoid antibiotic use in illnesses of likely viral etiology and others that tend to resolve spontaneously.”

“Also, no one would condone unnecessary caesarean delivery, and perhaps if mothers and fathers ask more questions about risks and benefits of their child’s delivery options the rates of this surgical procedure will fall somewhat.”

1Maternal and perinatal conditions and the risk of developing celiac disease during childhood

  • Namatovu F, Olsson C, Lindkvist M, Myléus A, Högberg U, Ivarsson A, Sandström O.

Study Conclusions

  • Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life.
  • High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.
  • We also found that maternal age with possible association to life style and diet (in particular breast feeding) is inversely related to CD risk
  • Additionally both findings were sex specific; differences in CD risk between boys and girls have been reported before and justify separate analysis in CD studies.
  • As a matter of fact, the considerable and well known higher CD risk in girls seen long before puberty is an interesting phenomenon that should be further studied.
  • All factors could be linked to the development of the immune system.

Future Considerations

  • Preventive strategies could benefit by taking measures to prevent gut dysbiosis.
  • Reduced prescription of antibiotics is one way that would also work to counteract the enormous problem with development of bacterial resistance to antibiotics.
  • Promoting normal delivery would also be in line with goals in the field of maternal and child health.
  • For some of our findings for example, increased CD risk was associated with being female, having maternal age 25–29 and being a second born, we could not establish a pathological mechanism.
  • However it is worth remembering that one important role of epidemiological studies is to generate new hypotheses and thereby contribute to future search for disease mechanisms, possible treatment and prevention.