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Antibiotic exposure and childhood attention-deficit/hyperactivity disorder: systematic review and meta-analysis

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Abstract

Background

Disturbances of gastrointestinal microbiome may result in the development of attention-deficit/hyperactivity disorder (ADHD). Antibiotic therapy is commonly known to influence the gastrointestinal microbiome. However, results from studies on the association between antibiotic exposure and ADHD have been inconsistent.

Methods

Several databases (PubMed, PsychInfo, EMBASE) were searched on January 1, 2021, to identify relevant studies. A random effects model was used to calculate the pooled risk estimate. Statistical heterogeneity was tested using the chi-square test and the I2 statistic.

Results

There were four risk estimates on antibiotic intake during pregnancy and eight risk estimates on antibiotic intake after birth. The pooled odds ratio for ADHD comparing antibiotic exposure with non-exposure during pregnancy was 1.14 (95% confidence interval [CI], 1.10–1.18). The pooled odds ratio with postnatal antibiotic exposure was 1.12 (95% CI, 0.99–1.26). Substantial heterogeneity existed among these analyses. The timing of antibiotic exposure, type of antibiotic, and number of antibiotic intakes might influence the association between antibiotic exposure and ADHD.

Conclusions

Our findings suggest that maternal antibiotic intake during pregnancy may be associated with an increased risk of ADHD in the offspring. However, there was insufficient evidence for the association between antibiotic intake after birth and ADHD risk. Further studies should be performed before a definitive conclusion can be established.

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Data availability

All data and materials, on which the conclusions of the manuscript rely, are included in the main paper and presented in the additional supporting files.

Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder (ADHD)

CI:

Confidence interval

OR:

Odds ratio

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Funding

This work was supported by the Xin Ya Fund (KX222).

Author information

Authors and Affiliations

  1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China

    Yuan Ai, Jing Zhao, Jing Shi & Ting Ting Zhu

  2. Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China

    Yuan Ai, Jing Zhao, Jing Shi & Ting Ting Zhu

Authors
  1. Yuan Ai
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  2. Jing Zhao
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  3. Jing Shi
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  4. Ting Ting Zhu
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Contributions

YA, TTZ, and JZ conceived and designed the study. JZ, TTZ, and YA conducted literature searches and data collection. JZ and TTZ performed the statistical analysis. YA, JZ, TTZ, and JS wrote manuscript. JS revised the manuscript.

Corresponding author

Correspondence to Ting Ting Zhu.

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This study did not report on or involve the use of any animal, individual person’s data in any form, human data, or tissue.

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The authors declare no competing interests.

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Ai, Y., Zhao, J., Shi, J. et al. Antibiotic exposure and childhood attention-deficit/hyperactivity disorder: systematic review and meta-analysis. Psychopharmacology 238, 3055–3062 (2021). https://doi.org/10.1007/s00213-021-05989-3

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  • DOI: https://doi.org/10.1007/s00213-021-05989-3

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