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Indirect antibiotic exposure during delivery is associated with a higher daytime-to-nighttime sleep ratio and fewer nighttime awakenings in infants at 2 and 6 months.

In a prospective birth cohort study of 192 infants, maternal antibiotic use during delivery was associated with a higher daytime-to-nighttime sleep ratio and fewer nighttime awakenings at 2 and 6 months of age. Effect sizes were small to moderate, indicating subtle alterations in sleep behavior rather than overt sleep disturbance.

Last updated: Jul 7, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Perinatal antibiotic exposure and infant sleep behavior: findings from the ABERRANT study.

observational

Markovic A, Kurth S, Zimmermann P · Pediatric research (2026)

Participants: N/A
Duration: 6 months (follow-up at 2 and 6 months)
Intervention: Indirect antibiotic exposure during delivery (maternal antibiotic use during delivery)
Outcome: Parent-reported sleep behavior (daytime-to-nighttime sleep ratio, nighttime awakenings, sleep latency) at 2 and/or 6 months
Effect Size: Small to moderate (specific values not reported in abstract)
Population: 192 infants (46% females) from a prospective birth cohort study

Result:

PubMed: 42380320DOI: 10.1038/s41390-026-05267-y

Mechanism Graph

Maternal antibiotics administered during delivery disrupt the developing infant intestinal microbiome
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Microbiome disruption alters neurodevelopmental signaling pathways
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Altered signaling affects sleep regulation centers in the developing brain
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Result: Subtle changes in infant sleep behavior (higher daytime-to-nighttime sleep ratio, fewer nighttime awakenings)

Limitations

  • ⚠Parent-reported sleep outcomes may be subject to recall bias or measurement error
  • ⚠Small to moderate effect sizes suggest clinical significance is uncertain
  • ⚠Observational design cannot establish causality; confounding factors may influence results

Frequently Asked Questions

What is the daytime-to-nighttime sleep ratio?▼

It is the proportion of total sleep occurring during daytime versus nighttime; a higher ratio indicates relatively more daytime sleep compared to nighttime sleep.

Does antibiotic exposure during pregnancy affect infant sleep?▼

The study found no significant associations for antibiotic exposure during the third trimester; only exposure during delivery was linked to sleep differences.

Are the sleep changes clinically significant?▼

The effect sizes were small to moderate, suggesting subtle alterations rather than overt sleep disturbances, so clinical significance is unclear.

What is the proposed mechanism linking antibiotics to sleep changes?▼

The study suggests that antibiotics disrupt the developing infant microbiome, which may in turn affect neurodevelopment and sleep regulation.

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References

  1. 1.Markovic A, Kurth S, Zimmermann P. "Perinatal antibiotic exposure and infant sleep behavior: findings from the ABERRANT study.." Pediatric research, 2026. PMID: 42380320 DOI: 10.1038/s41390-026-05267-y
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.