Infant wheezing and prenatal antibiotic exposure and mode of delivery: a prospective birth cohort study

Daleniece Higgins, Wilfried Karmaus, Yu Jiang, Pratik Banerjee, Irshad M. Sulaiman, Hasan S. Arshad

Research output: Contribution to journalArticlepeer-review


Introduction: Assessments on whether prenatal antibiotic exposure and mode of delivery increase the risk of wheezing in infants and toddlers are inconsistent. Our goal is to evaluate the association between prenatal antibiotic use and Cesarean section with three subtypes of wheezing in infancy. Methods: An ongoing prospective three generations cohort study provides data on prenatal antibiotic use and mode of delivery. Respective questionnaire data was used to distinguish three subtypes of wheezing: any wheezing, infectious wheezing, and noninfectious wheezing. Repeated measurements of wheezing at 3, 6, and 12 months were analyzed using generalized estimation equations. Latent transition analysis assessed patterns of infant wheezing development in the first year of life. Results: The prevalence of any wheezing was highest at 12 months (40.1%). The prevalence of infectious wheezing was higher (3 months 23.8%, 6 months 33.5%, 12 months 38.5%) than of noninfectious wheezing (3 months 13.0%, 6 months 14.0%, 12 months 11.1%). About 11–13% of children had both infectious and noninfectious wheezing at 3, 6, and 12 months (3 months 10.7%, 6 months 13.9%, 12 months 13.1%). Children born via Cesarean section have approximately a 70–80% increase in the risk of any wheezing (RR = 1.83, 95% CI 1.29–2.60) and of infectious wheezing (RR = 1.72, 95% CI 1.18–2.50). Conclusions: Analyses of infectious and noninfectious wheezing subtypes suggests that children born by Cesarean sections may be more susceptible to infectious wheezing, warranting investigations into microbial factors of infectious wheezing. No significant associations were found between prenatal antibiotic exposure and wheezing types.

Original languageEnglish (US)
Pages (from-to)770-781
Number of pages12
JournalJournal of Asthma
Issue number6
StatePublished - 2021
Externally publishedYes


  • Prenatal antibiotic use
  • cohort study
  • infant
  • infectious and noninfectious wheezing
  • mode of delivery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'Infant wheezing and prenatal antibiotic exposure and mode of delivery: a prospective birth cohort study'. Together they form a unique fingerprint.

Cite this