A Canadian study suggests that children who were not breastfed while receiving antibiotics in their first year of life had a triple risk of developing asthma because they lacked specific protective sugars found in human milk.
Dr Stuart Turvey, lead researcher, said antibiotics such as amoxicillin are commonly prescribed to treat a wide range of infections in young children, but the drugs are also linked to disrupting the development of a healthy gut microbiome.
“What we’ve known for some time is that babies who were given antibiotics at an early age were at higher risk of asthma at school age and beyond, but no one knew why,” said Turvey, a pediatrician at Children’s Hospital of British Columbia.
The study, published Wednesday in the journal Med, found that sugars in breast milk, which make up about 20 percent of indigestible carbohydrates, encourage the growth of B. infantis bacteria to help produce other bacteria to train the immune system and prevent the development of asthma and allergies.
The researchers also said they have identified sugars in breast milk that offer this protection, which could potentially be used as a supplement to formula for infants who need antibiotics but for whom breastfeeding is not an option.
“Babies are born with almost no bacteria,” Turvey said. “Then these communities (of bacteria) start to build up with pioneer species that help others colonize. So timing matters,” he said, when people are prescribed antibiotics that “confuse” children’s immune systems in the first few months of life.
The study included a total of 2,521 children in Vancouver, Edmonton, Winnipeg and Toronto. This shows that 17% of children received antibiotics in the first year of life.
Three groups of children were compared – those who did not receive antibiotics, those who were given them while breastfed, and those who took them without being breastfed.
When a subset of 1,338 children were three months old, the researchers collected a soiled diaper to test the feces. A year later, another diaper was taken for a stool sample from the same children, Turvey said, adding that the relatively new technology prohibits testing all children’s samples.
“We took the stool samples and then did metagenomics, a type of genetic sequencing, to identify all the bacteria by the DNA that’s there. It (B. infantis) came up as a really strong signal,” he said.
At age five, all children were assessed for asthma. Those who were not breastfed but were prescribed antibiotics were three times more likely to develop the condition.
“Children who received antibiotics while breastfeeding were not at higher risk than children who did not receive antibiotics,” Turvey said.
“One important thing was that all breastfeeding is protective. So it wasn’t just exclusive breastfeeding, no other form of feeding.
Asthma is a major reason children visit emergency rooms and doctor’s offices, often while out of school, he said, adding that despite the findings, amoxicillin is a potentially life-saving drug for very young children.
The results of the study could spur clinical trials to determine whether natural sugars in breast milk can be used to supplement formula to benefit people who cannot breastfeed, Turvey said. Chemists could make synthetic versions of the sugars similar to some already in formula, he added.
“More knowledge about safeguards could inform this process.”
Ailbhe Smyth, a volunteer with the Vancouver branch of La Leche League, which supports breastfeeding mothers, said those struggling with what is often a challenge, as it was for her, shouldn’t take the findings as another reason to they feel guilty about being a “perfect parent”.
Fewer public health clinics offered support through lactation specialists even before the pandemic, and some women are choosing private consultants to avoid long waiting lists, Smith said.
“But it’s still a barrier. Some people just don’t have the extra money to do that,” she said, adding: “I think the support shouldn’t just come from the health system, because it should come from society as a whole.”
This report by The Canadian Press was first published on January 5, 2023.
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Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP bears all responsibility for this content.
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