Early antibiotic exposure not linked to autoimmune disease in children

Early antibiotic exposure not linked to autoimmune disease in children | Image Credit: © Halfpoint - stock.adobe.com.

The incidence of autoimmune diseases in children has been increasing worldwide over the past several decades. However, a new study published August 21, 2025, in PLOS Medicine suggests that exposure to antibiotics during pregnancy or early infancy is not linked to an increased risk of autoimmune disease in children.^1,2

Researchers from Sungkyunkwan University, Republic of Korea, led by Ju-Young Shin, PhD, conducted a retrospective cohort study to evaluate whether antibiotic exposure in utero or during early infancy was associated with later diagnoses of autoimmune disease. The investigators utilized the South Korea National Health Insurance Service-National Health Insurance Database (NHIS-NHID), a large mother-child linked insurance claims dataset, to track outcomes.

Study design and methods

The cohort included more than 4 million children born in South Korea between April 1, 2009, and December 31, 2020. Mothers were identified based on antibiotic prescriptions received during pregnancy or while breastfeeding. Infants exposed to antibiotics in early life were also tracked. The children were followed for more than 7 years to identify new diagnoses of autoimmune disease.

Autoimmune outcomes monitored included type 1 diabetes, juvenile idiopathic arthritis, inflammatory bowel disease (ulcerative colitis and Crohn disease), systemic lupus erythematosus, and Hashimoto thyroiditis. The authors examined associations between antibiotic exposure and the incidence of these conditions across the study population.

Key findings

The researchers found no evidence of an increased risk of autoimmune disease associated with antibiotic exposure in either the prenatal period or during early infancy.

According to the authors, “Our findings suggest no association between antibiotic exposure during the prenatal period or early infancy and the development of autoimmune diseases in children. This observation contrasts with several previous studies reporting increased risks and underscores the importance of carefully considering the underlying indications for antibiotic use and genetic susceptibility when interpreting such associations. While the potential benefits of antibiotic treatment in managing infections during pregnancy or early infancy likely outweigh the minimal risk of autoimmune outcomes, our findings also highlight the need for cautious and clinically appropriate use of antibiotics during these critical developmental periods in specific subgroups.”

The authors emphasized that the results add clarity to conflicting evidence from prior investigations, some of which suggested that antibiotic exposure might alter immune development through gut microbiome disruption. The study’s large sample size and extended follow-up period strengthen the conclusions, though the researchers caution that subgroup analyses and studies in other populations are needed to confirm the results.

As the team noted, “Exposure to antibiotics during pregnancy or early infancy was not associated with an increased risk of autoimmune diseases in children. Nevertheless, the importance of follow-up studies to confirm and extend these findings cannot be overstated.”

Clinical implications

These findings provide reassurance for clinicians and patients regarding the use of antibiotics when medically indicated during pregnancy or breastfeeding. Although antibiotic stewardship remains a priority to minimize unnecessary use and antimicrobial resistance, this study suggests that fears about triggering autoimmune conditions in children may be unfounded.

The authors stressed that antibiotic use during these developmental periods should continue to be clinically guided, balancing the benefits of treating infections against any potential risks. The results also underscore the need for ongoing monitoring of large, diverse populations to better understand potential environmental contributors to pediatric autoimmune disease.

Conclusion

In this nationwide study of over 4 million children, early exposure to antibiotics, either prenatally or in infancy, was not associated with an increased incidence of autoimmune diseases during childhood. The findings contribute to the broader understanding of autoimmune disease risk factors and suggest that while prudent antibiotic use is essential, treatment during pregnancy or infancy does not appear to elevate autoimmune disease risk in children.