In recent decades, the global prevalence of autoimmune diseases among children has drawn increasing scientific attention, prompting rigorous investigation into potential early-life risk factors. Among these, the role of antibiotic exposure during critical developmental windows such as pregnancy and infancy has been hotly debated. A groundbreaking study published in PLOS Medicine offers compelling evidence that counters previous assumptions, showing no significant association between early antibiotic exposure and heightened risk of autoimmune diseases in children. This large-scale study, led by Ju-Young Shin and colleagues from Sungkyunkwan University in South Korea, presents a meticulous retrospective cohort analysis of over four million children, providing some of the most robust data to date on this important public health question.
Antibiotics have been a cornerstone of modern medicine, saving countless lives from bacterial infections. However, concerns have been raised about their impact on the developing immune system, especially during prenatal development and early infancy. These concerns stem from hypotheses about the intricate interplay between microbiome alterations and immune regulation, suggesting that disrupting the natural establishment of microbial communities might set the stage for autoimmune pathologies later in life. Previous observational studies hinted at an increased risk of autoimmune diseases following early antibiotic exposure, but their findings were often limited by confounding variables, small sample sizes, or incomplete data on timing and dosage of antibiotic use.
To cut through the noise, Shin and colleagues leveraged the comprehensive South Korea National Health Insurance Service-National Health Insurance Database (NHIS-NHID). This mother-child linked insurance claims database allowed researchers to identify cohorts of children born between April 2009 and December 2020 whose mothers received antibiotic prescriptions during pregnancy or while breastfeeding. By tracking these children’s health outcomes longitudinally for over seven years, the study encompassed data on diagnoses of multiple autoimmune diseases, including Type 1 diabetes, juvenile idiopathic arthritis, inflammatory bowel diseases (such as ulcerative colitis and Crohn’s disease), systemic lupus erythematosus, and Hashimoto’s thyroiditis.
The statistical analyses employed adjusted for a wide range of potential confounders, including maternal health conditions, socioeconomic factors, and delivery methods, to isolate the specific effect of antibiotic exposure. Remarkably, the findings revealed no significant increase in the overall incidence of autoimmune diseases among children exposed to antibiotics either prenatally or during early infancy. This null association persisted across diverse autoimmune conditions studied and held true even when stratified by the timing and extent of antibiotic use.
These results stand in contrast to earlier studies that reported a possible link between early antibiotic exposure and autoimmune risk. Shin et al. emphasize that such discrepancies likely reflect differing research methodologies, population characteristics, and the complexities inherent in immune system development. They caution against oversimplified conclusions, suggesting that genetic susceptibility, indication for antibiotic treatment, environmental factors, and microbiome diversity all interplay in nuanced ways that require further exploration.
The implications of this study are profound for clinical practice. While prudent and judicious use of antibiotics remains essential to combat antimicrobial resistance and preserve microbial ecology, this research supports the continued use of antibiotics when medically indicated during pregnancy and early infancy. The potential benefits in controlling maternal and infant infections appear to outweigh any minimal risk related to autoimmune disease development. Nevertheless, the authors advocate for targeted follow-up studies that might evaluate subpopulations potentially more vulnerable or gain finer granularity on antibiotic classes, dosages, and timing.
From a technical standpoint, the study’s design exemplifies rigorous epidemiological research by harnessing large-scale administrative datasets to answer complex questions about immune ontogeny and environmental exposures. The retrospective cohort approach facilitated real-world evidence generation with unparalleled statistical power, while mother-child linkage enhanced the accuracy of exposure assessment. However, the researchers acknowledge inherent limitations of observational studies, such as residual confounding and the absence of mechanistic biomarkers, underscoring the need for complementary experimental investigations.
One of the intriguing biological premises underlying past concerns is the impact of antibiotics on the infant gut microbiome—a critical architect of immune education. Disruptions in microbiota composition have been implicated in aberrant immune responses and autoimmunity in animal models. Nonetheless, Shin et al.’s findings suggest that if such microbiome perturbations occur due to antibiotic exposure, they may not translate straightforwardly into clinical autoimmune conditions, or compensatory mechanisms could mitigate potential harm. This invites further research employing metagenomic and immunophenotyping tools to delve deeper into host-microbe interactions.
Moreover, it is essential to interpret the study’s message within the broader context of immune-mediated diseases, which are multifactorial in origin. Genetic predisposition, environmental triggers, lifestyle factors, and stochastic processes collectively shape autoimmune risk. Antibiotic exposure is but one piece of a highly complex puzzle. The study reaffirms the need for personalized medicine approaches that consider individual susceptibility and carefully weigh risks and benefits in therapeutic decision-making during pregnancy and infancy.
Beyond its clinical relevance, this research sets a precedent for future large-scale pharmacoepidemiological studies that harness real-world data to explore early-life exposures. The vast data resource in South Korea provides a model for similar studies globally, enabling more generalizable insights and fostering international collaborations. Such endeavors are vital to deepen our understanding of how modern medical interventions intersect with human biology during critical developmental periods.
In summary, this seminal study by Shin and colleagues offers a reassuring perspective for clinicians, parents, and public health policymakers alike. By demonstrating no observable link between early antibiotic exposure and autoimmune disease risk in children on a nationwide scale, it challenges assumptions and encourages evidence-based antibiotic stewardship during pregnancy and infancy. At the same time, it leaves the door open for continued scientific inquiry into the complex mechanisms underlying immune tolerance and autoimmunity, highlighting the ever-evolving nature of medical knowledge.
As the global scientific community digests these findings, the overarching takeaway is one of cautious optimism. While vigilance remains warranted to minimize unnecessary antibiotic use, this study bolsters confidence that essential treatments in early life can be administered without undue fear of triggering autoimmune diseases. It is an important milestone in the journey toward safeguarding the health of future generations through balanced, data-driven medical care.
Subject of Research: People
Article Title: Exposure to antibiotics during pregnancy or early infancy and the risk of autoimmune disease in children: A nationwide cohort study in Korea
News Publication Date: August 21, 2025
Web References:
https://doi.org/10.1371/journal.pmed.1004677
References:
Choi E-Y, Bea S, Lee H, Choi A, Han JY, Kang EH, et al. (2025) Exposure to antibiotics during pregnancy or early infancy and the risk of autoimmune disease in children: A nationwide cohort study in Korea. PLoS Med 22(8): e1004677.
Image Credits:
neildodhia, Pixabay (CC0)
Keywords: antibiotics, autoimmune diseases, pregnancy, infancy, Type 1 diabetes, juvenile idiopathic arthritis, inflammatory bowel disease, systemic lupus erythematosus, Hashimoto’s thyroiditis, microbiome, immune system, cohort study, epidemiology
