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Association between early life (prenatal and postnatal) antibiotic administration and coeliac disease: a systematic review
  1. Maciej Kołodziej1,
  2. Bernadeta Patro-Gołąb1,
  3. Dorota Gieruszczak-Białek1,
  4. Agata Skórka1,
  5. Małgorzata Pieścik-Lech1,
  6. Ruth Baron2,
  7. Hania Szajewska1
  8. behalf of the SAWANTI Working Group
    1. 1 Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
    2. 2 Division Youth and Lifestyle, Vrije Universiteit Amsterdam - Sarphati Amsterdam, Amsterdam, The Netherlands
    1. Correspondence to Dr Hania Szajewska, Department of Paediatrics, The Medical University of Warsaw, Warsaw 01-184, Poland; hania{at}


    Objective Whether prenatal or postnatal exposure to antibiotics is associated with an increased risk of coeliac disease (CD) is unclear. We systematically reviewed studies on the association between early life antibiotic exposure and the risk of CD or CD autoimmunity.

    Design Systematic review of observational studies.

    Data sources The PubMed and Embase databases were searched up to December 2018, with no language restrictions. Additional references were obtained from reviewed articles.

    Eligibility criteria for selecting studies Cohort, cross-sectional and case–control studies that assessed the association between prenatal and/or postnatal antibiotic exposure and the odds of developing CD (as defined by authors of the original studies) or CD autoimmunity were eligible for inclusion.

    Results Six studies were included. In two large cohort studies that focused on prenatal antibiotic exposure, no association with the risk of CD was found (adjusted OR=1.16; 95% CI 0.94 to 1.43 and adjusted HR=1.33; 95% CI 0.69 to 2.56) in the Norwegian and Swedish cohorts, respectively. In three studies that evaluated the association of postnatal antibiotic exposure with the risk of CD, the results were contradictory, with only the Italian cohort study reporting a significant positive association (adjusted incidence rate ratio=1.24; 95% CI 1.07 to 1.43). A large, multicentre cohort study that evaluated the association between postnatal antibiotic exposure and CD autoimmunity in human leukocyte antigen (HLA)-positive subjects found no association.

    Conclusions We found no evidence of an association between prenatal or postnatal antibiotic exposure and CD.

    • celiac disease
    • antibiotics
    • prenatal
    • children
    • systematic review

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    • Contributors HS, MK and RB initially conceptualised this study. MK, BP-G, DG-B, AS and MP-L conducted the study. MK and BP-G analysed the data under the supervision of HS. MK had a primary responsibility for drafting the manuscript. All authors contributed to (and agreed on) the final version.

    • Funding Funded by the Medical University of Warsaw.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice The article type has been changed to Original article since this paper was published Online First.

    • Patient consent for publication Not required.