Antibiotics weaken breastfeeding’s benefits

The protective effects of breastfeeding against infections and overweight are reduced or eliminated by antibiotic use early in life, according to a retrospective study in 226 5-year-old Finnish children, almost all of whom had been breastfed for at least 1 month. The study also found that antibiotic use has a strong negative influence on microbiota composition.

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Investigators divided participants into 2 groups based on antibiotic use before or immediately after weaning: children who did not receive antibiotics during breastfeeding through 4 months after weaning and those who did receive antibiotics during breastfeeding through 4 months after weaning. Each of these 2 groups represented half of the total participants-113 children.

In the no antibiotics group, each month of breastfeeding decreased the number of postweaning antibiotic courses by 5% and body mass index (BMI) z score by 0.08 units at age 5 years. In the antibiotic user group, each month of breastfeeding reduced postweaning antibiotic courses by an estimated 4% (only borderline significant) and had no impact on BMI z score.

An analysis of the fecal microbiota composition of 42 study participants showed that among children with no early life exposure to antibiotics, those who were breastfed for up to 6 months had significantly fewer beneficial Bifidobacterium and Akkermansia than those who were breastfed longer (8 to 16 months). However, this benefit of long duration breastfeeding disappeared in children with early exposure to antibiotics (Korpela K, et al. JAMA Pediatr. 2016;170[8]:750-757).

Commentary

The intestinal microbiome may be the key to breast milk’s protective effect from both infection and from obesity. Antibiotic use early in life seems to disrupt the microbiome and may result in years-long impact on susceptibility to both. The era of the microbiome has arrived. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.