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New research from The Kids Research Institute Australia suggests a simple dietary intervention during pregnancy could help protect against the increased risk of food allergies associated with antibiotics taken before birth.
The findings, published in the international journal Allergy, show that among mothers who received antibiotics during labour, those who supplemented with a prebiotic during pregnancy did not have an increased risk of their baby developing food allergy.
In contrast, children born to mothers who received antibiotics but did not take prebiotics were more than five times more likely to develop a food allergy.
Lead author and Research Assistant at The Kids Research Institute Australia, Summer Walker, said around 1 in every 4 Australian mothers received antibiotic treatment during pregnancy, and up to half of infants were administered antibiotics in their first year of life.
“There has been increasing concern regarding the potential link between antibiotics and food allergies, with maternal antibiotic use during pregnancy shown to be associated with a higher risk of child eczema and food allergies,” Ms Walker said.
“We know that prebiotics promote the growth of healthy gut bacteria, while antibiotics disrupt the gut microbiome, by reducing diversity and potentially lead to a gut microbiome imbalance. During pregnancy this can potentially result in long-term child health effects.”
Antibiotics are often essential during labour and save lives, so they should always be used when needed. This research suggests there may be a simple way to reduce some of the potential long-term health effects for children, such as food allergies, by mothers consuming prebiotics during pregnancy.
As part of the SYMBA trial in Western Australia, researchers followed 652 pregnant women and their babies – the majority from ORIGINS, Australia’s largest longitudinal birth cohort of its kind - from mid-pregnancy until one year of age. Women consumed either a prebiotic or a placebo supplement from mid-pregnancy until their baby was six months old.
All babies had a family history of allergic disease, and more than 80 per cent of mothers and 20 per cent of babies received antibiotics during the study intervention period.
“Among mothers who did not take prebiotics, antibiotic exposure during labour was associated with a more than five‑fold increase in food allergy risk in babies,” Ms Walker said.
“Our findings suggest a particularly vulnerable period around birth where antibiotic use may negatively influence a baby’s developing immune system.”
Previous research has often grouped together antibiotics given during labour and those given for caesarean births. In this study, researchers looked at these separately.
“Antibiotic levels peak in the umbilical cord within 30 minutes and remain bactericidal for several hours, regardless of labour duration. Consequently, labour antibiotics may have a greater impact on the infant microbiome due to longer fetal exposure,” Ms Walker said.
“This research is an important first step and opens the door to exploring whether prebiotics could also help protect against other child health conditions linked to antibiotics.
“For now, it’s best for women to follow existing dietary advice and speak with their healthcare provider before starting supplements.
“The good news is that many healthy diets, such as the Mediterranean diet, are rich in prebiotic containing foods such as garlic, leeks, onions, asparagus and legumes.”
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Summer Walker is first author of the paper and a PhD candidate and research assistant at The Kids Research Institute
"Antibiotics given during labour are essential, life-saving medicines and should always be used when needed. However, there has been increasing evidence that antibiotics given around the time of birth may influence a baby's developing immune system and increase the risk of allergic disease. In our study, mothers who received antibiotics during labour but took a prebiotic supplement during pregnancy did not have an increased risk of their baby developing a food allergy.
In contrast, babies born to mothers who received antibiotics but did not take prebiotics were more than five times more likely to develop a food allergy. These findings suggest a particularly vulnerable period around birth where antibiotic use may negatively influence a baby’s developing immune system.
Around one in four women receives antibiotics during labour, yet there are currently no strategies to reduce any potential long-term effects on children's allergy risk. While more research is needed, our findings provide an important first step towards developing a simple nutritional strategy to support healthy immune development and could potentially help protect against some unintended effects of medically necessary antibiotics."
Professor Pete Smith is an allergist at Griffith University
"This is an important and biologically plausible finding that strengthens the case that the early-life microbiome shapes a child's risk of allergy. In this Western Australian trial of infants at high familial risk, those whose mothers received antibiotics during labour had a much higher risk of allergic disease — roughly a six-fold increase in food allergy and atopic eczema, and around three-fold in allergen sensitisation. Strikingly, that excess risk was not seen when the mother took prebiotic supplements.
The effect size is large and deserves attention. But I would urge caution: this was an exploratory secondary analysis, the number of affected infants was very small, and the confidence intervals are wide. The authors rightly call it hypothesis-generating, and because no microbiome, metabolic pathways or genome studies were measured, we cannot yet say how the prebiotics are acting.
Two messages matter for parents. First, antibiotics in labour - most often given to prevent Group B streptococcus - are important and sometimes lifesaving, and should not be avoided. Second, these results make a strong case for larger trials testing whether supporting the maternal microbiome can offset this risk. It is a promising lead, not yet a recommendation.
Realistically and practically, prebiotics are safe and have minimal costs and appear to convey benefit - more studies are required before this becomes a guideline. Also congrats to the authors for the study and publication! Thousands of hours of work to get us closer to understanding why we have food allergy and eczema."
Associate Professor Joanna Harnett is a complementary medicines expert from the Faculty of Medicine and Health, School of Pharmacy at the University of Sydney
"Identifying complementary strategies to minimise any unintended adverse effects associated with essential antibiotic treatment is an important area of research. Compared with probiotics, the potential role of prebiotics in mitigating antibiotic-associated adverse effects has received considerably less research attention.
The question is biologically plausible, building on studies that show antibiotics can disrupt early microbial colonisation, that early-life microbial exposures influence immune development, and that prebiotics may favourably alter microbiome composition and function. However, the study findings should be viewed as hypothesis-generating rather than evidence of a causal relationship. They highlight the need for further research into the potential mechanisms, benefits and harms of prebiotic supplementation (perhaps versus dietary prebiotic) exposure during pregnancy and early life.
Importantly, the study did not assess maternal gut, vaginal or breastmilk microbiomes, nor the infant gut microbiome, and no immune biomarker data were collected. Consequently, it cannot determine whether prebiotics modified antibiotic-associated changes in the microbiome or whether such changes contributed to the observed allergy outcomes. The findings provide data that warrants further mechanistic investigation in adequately powered studies incorporating microbiome and immune assessments."
