Group B Streptococcus antibiotics treatment during pregnancy and the risk of four neurodevelopmental outcomes in Swedish children.

Recent studies have suggested an association between prenatal and early life antibiotics with adverse neurodevelopmental outcomes in children. As antibiotics during pregnancy are commonly prescribed, our aim was to estimate the association the groups of antibiotics prescribed for GBS during pregnancy the risk of neurodevelopmental outcomes in children. This population-based cohort study included all live births in Sweden from 2006 to 2016 (n = 1,066,777). Individual informed consent was not required, as the study used data from national registers and involved no direct participant contact. Using multivariable Cox Regression models and GEE models for secondary assessment we measured the association between seven first line treatment GBS antibiotics during pregnancy and (1) intellectual disability, (2) cerebral palsy, (3) autism spectrum disorder (ASD), and (4) attention deficit hyperactivity disorder (ADD/ADHD) as recorded in high-quality Swedish registers. GBS antibiotics were prescribed to 22.1% of mothers included. We found no association between GBS antibiotics and the risk of intellectual disability. However, a modest association was observed for cerebral palsy (aHR 1.17, 95%CI 1.06-1.29), ASD (aHR 1.12, 95%CI 1.07-1.17), and ADHD/ADD (aHR 1.17, 95%CI 1.12-1.22). This association was also seen when only including children born at term, and only children of mothers without autism spectrum disorder or ADHD diagnosis. The results were model dependent, as GEE models did not always show the same associations. Although the results could be affected by residual confounding or confounding by indication (as GBS infection has been associated with neurodevelopmental outcomes), they highlight the need for further studies on GBS antibiotic use during pregnancy, increased antibiotic stewardship with individual risk assessment and other treatment options for GBS, when needed.