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Intrapartum group B Streptococcal prophylaxis and childhood weight gain
  1. Sagori Mukhopadhyay1,
  2. Matthew Bryan2,
  3. Miren B Dhudasia3,
  4. William Quarshie4,
  5. Jeffrey S Gerber5,
  6. Robert W Grundmeier6,
  7. Corinna Koebnick7,
  8. Margo A Sidell7,
  9. Darios Getahun8,
  10. Andrea J Sharma9,
  11. Michael W Spiller10,
  12. Stephanie J Schrag10,
  13. Karen Marie Puopolo1
  1. 1 Pediatrics, Neonatology, Center for Pediatric Clinical Effectiveness, Childrens Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Independent Statistician, Ottawa, Ontario, Canada
  3. 3 Pediatrics, Neonatology, Center for Pediatric Clinical Effectiveness, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  4. 4 Pediatrics, Center for Pediatric Clinical Effectiveness, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
  5. 5 Pediatrics, Infectious Diseases, Center for Pediatric Clinical Effectiveness, Childrens Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6 Pediatrics, Center for Pediatric Clinical Effectiveness, Childrens Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
  7. 7 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
  8. 8 Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
  9. 9 National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
  10. 10 National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, USA
  1. Correspondence to Dr Sagori Mukhopadhyay, Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania 19146, USA; mukhopadhs{at}email.chop.edu

Abstract

Objective To determine the difference in rate of weight gain from birth to 5 years based on exposure to maternal group B streptococcal (GBS) intrapartum antibiotic prophylaxis (IAP).

Design Retrospective cohort study of 13 804 infants.

Setting Two perinatal centres and a primary paediatric care network in Philadelphia.

Participants Term infants born 2007–2012, followed longitudinally from birth to 5 years of age.

Exposures GBS IAP defined as penicillin, ampicillin, cefazolin, clindamycin or vancomycin administered ≥4 hours prior to delivery to the mother. Reference infants were defined as born to mothers without (vaginal delivery) or with other (caesarean delivery) intrapartum antibiotic exposure.

Outcomes Difference in rate of weight change from birth to 5 years was assessed using longitudinal rate regression. Analysis was a priori stratified by delivery mode and adjusted for relevant covariates.

Results GBS IAP was administered to mothers of 2444/13 804 (17.7%) children. GBS IAP-exposed children had a significantly elevated rate of weight gain in the first 5 years among vaginally-born (adjusted rate difference 1.44% (95% CI 0.3% to 2.6%)) and caesarean-born (3.52% (95% CI 1.9% to 5.2%)) children. At 5 years, the rate differences equated to an additional 0.24 kg among vaginally-born children and 0.60 kg among caesarean-born children.

Conclusion GBS-specific IAP was associated with a modest increase in rate of early childhood weight gain. GBS IAP is an effective intervention to prevent perinatal GBS disease-associated morbidity and mortality. However, these findings highlight the need to better understand effects of intrapartum antibiotic exposure on childhood growth and support efforts to develop alternate prevention strategies.

  • neonatology
  • growth
  • obesity

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @sagori, @MDhudasia

  • SM and KMP contributed equally.

  • Contributors SM conceptualised and designed the study, contributed to data curation, analysis and interpretation of results, drafted the initial manuscript and reviewed and revised the manuscript. MB contributed to study design and analytic plan, conducted analysis and provided interpretation of results and reviewed and revised the manuscript. MBD contributed to data collection, curation, analysis and management, and reviewed and revised the manuscript. WQ contributed to data analysis and management, and reviewed and revised the manuscript. RWG contributed to data acquisition and management, study design and analytic plan and reviewed and revised the manuscript. JSG, CK, DG, AJS, MWS, SJS and MAS contributed to study design and analytic plan, and reviewed and revised the manuscript. KMP conceptualised and designed the study, contributed to interpretation of results and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding This study was supported by a contract with the Centres for Disease Control and Prevention (CDC 200-2017-96221), and by Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) of the National Institutes of Health (NIH) grant (#K23HD088753). SJS, MWS and AJS were employees of the CDC during the study and were involved in design and conduct of the study, interpretation of the data and preparation and review of the manuscript.

  • Disclaimer NICHD/NIH had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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