The antibiotic effect in pregnancy and at birth
There is absolutely no doubt that antibiotics save lives. The world before they were discovered saw huge loss of life from what are now treatable infections, however, we now know that they come with a cost. Our microbes are crucial part of how we function as humans and while antibiotics can help fight infection, they disrupt all our microbes during the treatment.
"A single course of antibiotics can change the composition of oral and gut microbiomes for at least a year, according to a modelling study by UCL researchers. Moreover, this change leads to a decrease in the number and types of microbes found in the gut"
This matters as antibiotics are the most commonly prescribed medication in pregnancy. An Australian University study in 2018 found that 12% of Australian women took antibiotics in pregnancy. Now to be clear while infections during pregnancy are common, untreated bacterial infections can be life-threatening and so if a pregnant woman needs antibiotics she absolutely should take them, but caution should be used when prescribing.
Research from Denmark, that used data from over 770,000 children found when antibiotics were used late in pregnancy this increased the risk of infection in vaginally born infants.
"The overall increased risk occurred regardless of infection type; whether it’s invasive bacterial, viral, gastrointestinal, lower respiratory tract, upper respiratory tract, genitourinary, skin or soft tissue. ... A child’s gut microbiome is particularly important in gastrointestinal infections"
(Professor David Burgner and Dr Jessica Miller, University of Melbourne 2018)
2018 Repeated prenatal exposure to antibiotics was associated with childhood obesity at age 7 years, and risk of obesity tended to increase with an increasing number of antibiotic exposures.
2017 – When mice with a genetic predisposition to inflammatory bowel disease (IBD) were given antibiotics during late pregnancy and the early nursing period, their offspring were more likely to develop an inflammatory condition of the colon that resembles human IBD.
2015 - Antibiotic use during the third trimester of pregnancy leads to an increased risk of childhood wheeze (link not found in first trimester)
Remember that antibiotics absolutely are necessary sometimes and should not be avoided when needed. If you do need to take them, make sure you eat a really healthy diet and consider taking a supplement.
GROUP B STREP
GBS AND THE MICROBIOME
In many countries pregnant women are routinely screened for GBS (not here in the UK) and when there is a postive test, antibiotics are given in labour to reduce the risk of transmission to the baby. Of the approximately 25% of women who carry GBS, in a tiny number it will lead to infant infections resulting in serious illness and even death. Antibiotic treatment is an important prevention strategy in the treatment of GBS.
The trouble is that those antibiotics also disrupt the infant microbiome in early life. A study from McMasters University found that the infants who had the antibiotics in labour had "dramatically" altered gut bacteria in early life although this difference had narrowed by 12 weeks. Again this is significant as it's the early life microbia that train the immune system.
This study found that exposure of infants to IAP [intraprtum antibiotics] for GBS during vaginal birth affected aspects of gut microbial ecology that, although dramatic at early time points, disappeared by 12 weeks of age in most infants.
From: Intrapartum antibiotics for GBS prophylaxis alter colonization patterns in the early infant gut microbiome of low risk infants
There is no easy solution here, but when deciding whether to have the antibiotics in labour, the effect on the microbiome should be part of the risk/benefit analysis.
There really also needs to be much more research into targeted solutions that tackle the GBS bacteria alone.
IF I NEED ANTIBIOTICS, WHAT ABOUT PROBIOTIC SUPPLEMENTS?
The best source of probiotics is always food, but if your diet is not as varied as you would like, or if you can't tolerate lots of vegetables or dairy produects well then probiotics might help.
The evidence is not strong on their effectiveness however sometimes, every little helps as they say. You should always consult your health provider before use.
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