Project Details

The impact of antenatal antibiotics on child neurodevelopment and growth in rural Zimbabwe

Andrew Prendergast, MBBS, MRCPCH, DTM&H, DPhil

Summary

BACKGROUND: Globally, 200 million children fail to reach their full developmental potential due to stunting and poverty. There is a need for new antenatal strategies that improve the trajectory of child growth and development, while avoiding exposure to interventions that have damaging long-term effects during the sensitive period of brain development in utero. GAP: Does exposure to prophylactic antibiotics during pregnancy promote healthy infant growth and development, or is antenatal antibiotic exposure associated with adverse long-term effects including impaired neurodevelopment, disability, and behavioural problems? HYPOTHESIS: Antenatal broad-spectrum prophylactic antibiotics throughout pregnancy improve child growth and neurodevelopment at 2 years of age. METHODS: Long-term follow-up of a double-blind, placebo-controlled, randomized trial among 1000 women in rural Zimbabwe. Women from three antenatal clinics in Shurugwi district, Zimbabwe, were randomized to prophylactic cotrimoxazole (960mg daily) or matched placebo until delivery, with a primary outcome of infant birthweight. In this follow-up study, mother-child pairs who were in the original trial and are able to attend a study clinic visit at age 2 years will be invited to re-consent to assess child neurodevelopment using the Malawi Developmental Assessment tool (primary endpoint), disability, behaviour, growth and health (all secondary endpoints), to compare long-term outcomes between randomized arms. RESULTS: Pending. IMPACT: If prophylactic antibiotics improve child growth and neurodevelopment, it provides a strong rationale to scale up cotrimoxazole within antenatal care in low-income countries; however, if antibiotic exposure leads to an increased risk of impaired neurodevelopment, disability or other long-term health deficits, it provides a public health rationale to reduce exposure to antibiotics during pregnancy. Website Link: www.zvitambo.com