{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:38:39Z","timestamp":1789706319609,"version":"4.0.1"},"reference-count":101,"publisher":"Royal College of Psychiatrists","issue":"3","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec id=\"S0007125024001211_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prenatal and early-life periods pose a crucial neurodevelopmental window whereby disruptions to the intestinal microbiota and the developing brain may have adverse impacts. As antibiotics affect the human intestinal microbiome, it follows that early-life antibiotic exposure may be associated with later-life psychiatric or neurocognitive outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001211_sec_a2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore the association between early-life (in utero and early childhood (age 0\u20132 years)) antibiotic exposure and the subsequent risk of psychiatric and neurocognitive outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001211_sec_a3\" sec-type=\"methods\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A search was conducted using Medline, PsychINFO and Excerpta Medica databases on 20 November 2023. Risk of bias was assessed using the Newcastle-Ottawa scale, and certainty was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) certainty assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001211_sec_a4\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty studies were included (\n                      <jats:italic>n<\/jats:italic>\n                      = 7 047 853 participants). Associations were observed between\n                      <jats:italic>in utero<\/jats:italic>\n                      antibiotic exposure and later development of autism spectrum disorder (ASD) (odds ratio 1.09, 95% CI: 1.02\u20131.16) and attention-deficit hyperactivity disorder (ADHD) (odds ratio 1.19, 95% CI: 1.11\u20131.27) and early-childhood exposure and later development of ASD (odds ratio 1.19, 95% CI: 1.01\u20131.40), ADHD (odds ratio 1.33, 95% CI: 1.20\u20131.48) and major depressive disorder (MDD) (odds ratio 1.29, 95% CI: 1.04\u20131.60). However, studies that used sibling control groups showed no significant association between early-life exposure and ASD or ADHD. No studies in MDD used sibling controls. Using the GRADE certainty assessment, all meta-analyses but one were rated very low certainty, largely owing to methodological and statistical heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001211_sec_a5\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While there was weak evidence for associations between antibiotic use in early-life and later neurodevelopmental outcomes, these were attenuated in sibling-controlled subgroup analyses. Thus, associations may be explained by genetic and familial confounding, and studies failing to utilise sibling-control groups must be interpreted with caution. 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