Maternal Prebiotic Supplementation Modifies Associations Between Intrapartum Antibiotics and Infant Allergy.

Abstract

Prebiotics promote growth of beneficial gut bacteria, whereas antibiotics can disrupt the microbial balance, reduce diversity, and potentially cause gut dysbiosis. This investigation aimed to determine whether antibiotic use before, during, or after birth altered the risk of infant allergic disease outcomes within a maternal prebiotic dietary supplementation trial. Maternal participants were allocated to consume daily prebiotics (galacto-oligosaccharides and fructo-oligosaccharides) or placebo (maltodextrin) powder from 18 to 20 weeks' gestation until 6 months postnatal. All infants had a family history of allergic disease. Maternal and infant antibiotic use was prospectively collected monthly throughout the trial intervention period, and infant allergic disease was assessed by 1 year of age. Overall, 83.1% (472/568) mothers and 20.8% (115/554) infants received antibiotics during the trial intervention period. Prebiotic supplementation modified the association between maternal intrapartum antibiotic exposure and infant allergic disease. Among women not consuming prebiotics, maternal intrapartum antibiotics were associated with an increased risk of infant allergen sensitisation (adjusted relative risk [aRR] 3.56, 95% CI 1.65-7.69), IgE-mediated food allergy (aRR 5.67, 95% CI 2.04-15.73), and medically diagnosed atopic eczema (aRR 6.42, 95% CI 2.43-16.95); such associations were not evident in women consuming prebiotics. Maternal and infant antibiotics administered during other intervention phases were not significantly associated with any infant allergic disease outcomes. Our exploratory investigation findings indicate that maternal prebiotics supplementation reduces the risk of infant allergen sensitisation, food allergy and atopic eczema associated with intrapartum antibiotic use. Future allergy prevention trials could further optimise maternal prebiotic interventions during the intrapartum period.