Re: Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study
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Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study
Re: Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study
Dear Editor
I would like to congratulate the authors on the success of the study (BMJ 2024;385:e076885). Multiple neurodevelopmental disorders are included in autism spectrum disorder (ASD). Repetitive patterns of behavior, interests, and hobbies, as well as difficulties in social situations, define this spectrum. Due to their limited ability to adjust, these children get upset when anything changes in their immediate environment (1). In this large cohort analysis, antibiotic exposure during pregnancy or early infancy was not linked to an elevated risk of autism spectrum disorder, intellectual disability, or linguistic disorder in children. However, higher risks were detected in some subgroups, including children who received antibiotics at a young age and those who used antibiotics for an extended period of time, necessitating further attention and inquiry. Furthermore, even after controlling for reasons and family variables, antibiotic usage during infancy was found to have a slight association with epilepsy. Early-life gut microbiome disruption by antibiotics is associated with some neurodevelopmental disorders.
But I would like to mention some shortcomings of the study. First, it may happen that the woman uses some antibiotics not prescribed to her by anyone, or she may use some other generation of the same drug that may exert different effects on the brain development of the baby. Lack of history of the pregnant woman who may be taking some other drugs, i.e., immunosuppressives, may cause adverse drug interactions with antibiotics (2). Thus, further research with validated data is required. The diagnosis of autism spectrum disorder must be validated by the diagnostic tools CARS and ADOS (3), not used in this research. Any information regarding maternal alcoholic status, paternal age, and maternal nutritional status, i.e., iron and folate levels, was not known.
The severity of infection must be assessed by the serology or microbiological cultures not done in this research, and then the antibiotics must be prescribed for a suitable duration. This necessitates further research (4). And as the research was conducted in the COVID-19 period, results may vary due to the quarantine of the pregnant women not going for proper hospital visits for any infections they had. Further research is necessary to get complete exposure and accurate results.
References:
1. Mughal S, Faizy RM, Saadabadi A. Autism Spectrum Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK525976/
2. Berdaguer S, Bautista J, Brunet M, Cisneros JM. Antimicrobial and immunosuppressive drug interactions in solid organ transplant recipients. Enferm Infecc Microbiol Clin. 2012 Mar;30 Suppl 2:86–92.
3. Santos CLD, Barreto II, Floriano I, Tristão LS, Silvinato A, Bernardo WM. Screening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis. Clin Sao Paulo Braz. 2024;79:100323.
4. Haselbeck AH, Im J, Prifti K, Marks F, Holm M, Zellweger RM. Serology as a Tool to Assess Infectious Disease Landscapes and Guide Public Health Policy. Pathogens. 2022 Jun 27;11(7):732.
Rapid Response:
Re: Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study
Dear Editor
I would like to congratulate the authors on the success of the study (BMJ 2024;385:e076885). Multiple neurodevelopmental disorders are included in autism spectrum disorder (ASD). Repetitive patterns of behavior, interests, and hobbies, as well as difficulties in social situations, define this spectrum. Due to their limited ability to adjust, these children get upset when anything changes in their immediate environment (1). In this large cohort analysis, antibiotic exposure during pregnancy or early infancy was not linked to an elevated risk of autism spectrum disorder, intellectual disability, or linguistic disorder in children. However, higher risks were detected in some subgroups, including children who received antibiotics at a young age and those who used antibiotics for an extended period of time, necessitating further attention and inquiry. Furthermore, even after controlling for reasons and family variables, antibiotic usage during infancy was found to have a slight association with epilepsy. Early-life gut microbiome disruption by antibiotics is associated with some neurodevelopmental disorders.
But I would like to mention some shortcomings of the study. First, it may happen that the woman uses some antibiotics not prescribed to her by anyone, or she may use some other generation of the same drug that may exert different effects on the brain development of the baby. Lack of history of the pregnant woman who may be taking some other drugs, i.e., immunosuppressives, may cause adverse drug interactions with antibiotics (2). Thus, further research with validated data is required. The diagnosis of autism spectrum disorder must be validated by the diagnostic tools CARS and ADOS (3), not used in this research. Any information regarding maternal alcoholic status, paternal age, and maternal nutritional status, i.e., iron and folate levels, was not known.
The severity of infection must be assessed by the serology or microbiological cultures not done in this research, and then the antibiotics must be prescribed for a suitable duration. This necessitates further research (4). And as the research was conducted in the COVID-19 period, results may vary due to the quarantine of the pregnant women not going for proper hospital visits for any infections they had. Further research is necessary to get complete exposure and accurate results.
References:
1. Mughal S, Faizy RM, Saadabadi A. Autism Spectrum Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK525976/
2. Berdaguer S, Bautista J, Brunet M, Cisneros JM. Antimicrobial and immunosuppressive drug interactions in solid organ transplant recipients. Enferm Infecc Microbiol Clin. 2012 Mar;30 Suppl 2:86–92.
3. Santos CLD, Barreto II, Floriano I, Tristão LS, Silvinato A, Bernardo WM. Screening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis. Clin Sao Paulo Braz. 2024;79:100323.
4. Haselbeck AH, Im J, Prifti K, Marks F, Holm M, Zellweger RM. Serology as a Tool to Assess Infectious Disease Landscapes and Guide Public Health Policy. Pathogens. 2022 Jun 27;11(7):732.
Competing interests: No competing interests