Antibiotics during infancy and its effect on later mental and cognitive health

There is increasing concern about the over-use of antibiotics. It is associated with antibiotic resistance and can significantly affect the composition of our gut microbiome. When given to infants and children, concerns are expressed about their long-term effects

In a recent study, the association between early life antibiotic exposure and later neurocognitive outcomes were investigated [1].

Information was obtained from 474 mothers about antibiotic use in their infants. Children were then followed up and underwent a neurocognitive assessment at age 11. After adjustment for breastfeeding and income class, it was found that children who received antibiotics in the first 6 months of life had significantly lower overall cognitive and verbal comprehension abilities, increased risk of problems with metacognition, executive function, impulsivity, hyperactivity, attention-deficit hyperactivity disorder, anxiety and emotional problems.

These results are similar to those obtained in a nationwide study conducted in Denmark [2]. Infants were followed up for an average of 9 years. Those who experienced an infection requiring hospitalisation had an 84% increased risk of experiencing a mental health disorder. Being treated with an ‘anti-infective’ medication, particularly antibiotics, was associated with a 40% increased chance of being diagnosed with a mental health disorder in later childhood/adolescence.

There is an increasing understanding of the important relationship between the gut and the brain. Our gut bacteria (microbiota) have many important roles including:

• producing vitamins and minerals
• safeguarding us from external pathogens
• aiding in the metabolism of sugars and lipids
• modulating intestinal motility
• supporting our immune response
• producing hormones and neurotransmitters. These include mood-supporting neurotransmitters such as serotonin, noradrenaline, dopamine, and GABA.

Unfortunately, antibiotics significantly affect our gut microbiota. Although in adults this effect can be transient (if used for a short time), in infants and children it can lead to long-standing disruptions.

To ensure optimal gut health and improved microbial diversity it is important to limit antibiotic use as much as possible. In addition, eating a healthy diet comprising an abundance of plant-based foods, healthy fats, and foods high in fibre can improve the composition of our gut bacteria. Limiting high-sugar foods, takeaway foods, alcohol, and even reducing stress, ensuring good sleep, and being physically active can enhance gut health. Probiotics can also support gut health and positively affects immunity. Interestingly, all these factors have been shown to influence our mental health.

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References

1. Slykerman RF, et al. Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age. Psychopharmacology (Berl). 2019 Apr 30. link to article
2. Köhler-Forsberg O, et al., A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents. JAMA Psychiatry. 2018 Dec 5. link to article