Intrapartum Antibiotic Prophylaxis and Child Health Outcomes: A Systematic Review and Meta-Analysis of Observational Studies.

Abstract

With increasing use of intrapartum antibiotic prophylaxis (IAP) for the prevention of early-onset Group B streptococcus (GBS) infections, there is concern about its long-term consequences on child health. To synthesise the evidence of IAP exposure on autoimmune-related diseases, obesity in childhood and microbial diversity in infants. PubMed, Web of Science, Emcare, Embase and Scopus were searched from inception until 17 July 2025 for related observational studies. The exposure group comprised mothers with full-term vaginal deliveries who underwent GBS screening and received IAP, while the comparator group included mothers with full-term vaginal deliveries with GBS-negative results and no IAP exposure. Results were pooled using fixed or random-effects meta-analysis based on heterogeneity assessed by the I² statistic. Sixteen studies were eligible to be included in the meta-analysis. IAP exposure was associated with an increased risk of autoimmune-related disease (6 studies, relative risks (RRs) = 1.73; 95% confidence interval [CI]: 1.08-2.78; I² = 94.8%). Subgroup analysis based on types of autoimmune-related diseases showed a significant increase in the risk of atopic dermatitis (3.44; 1.60-7.37). There was a modest increase in child BMI (2 studies, standardised mean difference = 0.05; 95% CI: 0.03-0.06; I² = 50.09%), but not BMI z-score (3 studies, 0.13; 0.03-0.29; I² = 72.05%) or microbiome diversity in infants (6 studies, -0.09; -0.20 to 0.02; I² = 0.00%) born to pregnant women exposed to IAP compared to non-exposed women. IAP exposure is associated with an increased risk of autoimmune-related disease and a modest increase in child BMI. PROSPERO (CRD42023493413).