Obesity has become a significant concern for the U.S. healthcare system. Heerman et al. (2019) argued that identifying early determinants of obesity can assist with developing obesity prevention strategies. Their original research is focused on exploring the possible connection between maternal antibiotic use and BMI (Body Mass Index) increase in children of the 5-year old age group. This work evaluates the validity of the study conducted by Heerman et al. and examines the feasibility of its application in nursing practice.
The main problem highlighted in the study was the divergence of findings on maternal antibiotic exposure and childhood obesity risk. Given these circumstances, Heerman et al. (2019) aimed to deliver a comprehensive retrospective cohort study in order to explore various sub-groups within a large research sample. As a result, the investigators placed the problem within the context of the existing knowledge in healthcare. Moreover, their goal lied in expanding the knowledge on possible impacts of maternal antibiotic exposure. As such, the results can help pediatric nursing personnel with decision-making in antibiotic prescribing since they provide empirical support in the shape of research-based information.
The researchers reviewed several studies on multiple early life exposures and their possible association with childhood obesity. For instance, Mor et al. (2015) revealed a higher obesity prevalence among the 7-16 years old children exposed to prenatal antibiotics. On the contrary, Poulsen et al. (2017) reported the increased risks of childhood obesity in 3-year old children only because antibiotics in pregnancy were associated with children receiving antibiotics in early life. Overall, Heerman et al. (2019) used that divergence in other extensive contemporary studies’ findings to justify the need for a large scope quantitative analysis. Maternal outpatient antibiotic exposure and childhood obesity risk were the key concepts explored in the brief literature review.
The authors did not provide clear identification of their assumptions or any theoretical framework for the study. In this regard, their study should be viewed as comprehensive empirical research in pediatric nursing rather than a theory-based work. Moreover, since the research draws upon the evident divergence of previous findings on the subject, one can state that the lack of explicit preliminary assumptions is justified. The researchers did not openly assume that Mor et al. (2015) or Poulsen et al. (2017) were correct or incorrect in their respective conclusions. Due to this impartial approach, Heerman et al. (2019) were able to eliminate any cognitive bias, as they only gathered empirical data and analyzed it. As such, suggesting a formal theory for this study would be irrelevant since its design was intended to be strictly empirical.
The research hypotheses are not stated clearly; however, one can quickly draw them from the available background information. Essentially, there are two implied opposite hypotheses, which the authors intended to examine. First — maternal antibiotic exposure during pregnancy can possibly lead to childhood obesity. Second — the risk of childhood obesity due to maternal antibiotic exposure is insignificant, almost nonexistent. Consequently, outpatient maternal antibiotic prescriptions served as the main independent variable, while age- and sex- specific BMI was considered the primary outcome (Heerman et al., 2019). In addition, the authors provided a clear and concrete measurement of the dependent variable and factors affecting its change in the shape of linear regression results. For example, a history of smoking during pregnancy had a β coefficient of 0,15, while antibiotic exposure yielded a β coefficient of 0,00 (Heerman et al., 2019). Therefore, the researchers managed to calculate the impact of factors affecting childhood obesity and present a clear representation of their findings.
The authors utilized quantitative design in order to gather, analyze, and represent research data. They have assessed relevant information from seven healthcare institutions’ electronic health records (EHRs) (Heerman et al., 2019). The reasoning used in the study was closer to deductive since the final goal lied in examining two equally possible hypotheses related to maternal antibiotic exposure and childhood obesity. In the end, the authors created a massive research sample of 53,320 mother-child pairs, which met the inclusion criteria (Heerman et al., 2019). The key inclusion criterion was data availability on mother’s vitals during pregnancy and child’s BMI at 5-year age (Heerman et al., 2019). As such, the research utilized non-probability purposive sampling since sample selection was made in accordance with specific pre-determined inclusion criteria with a goal to prove one of the two existing hypotheses.
The independent variable of maternal antibiotic exposure was surveyed via the information from the EHRs. The dependent variable of the factor’s association with a child’s BMI at the age of 5 was measured via linear mixed effects regression models (Heerman et al., 2019). Using these tools, the researchers obtained valid quantitative results, which confirmed the lack of connection between maternal antibiotic exposure and childhood obesity. In regard to ethical considerations, the authors explicitly stated the absence of any conflicts of interest and obtained approval from the Harvard Pilgrim Institutional Review Board (Heerman et al., 2019). In addition, all details from the personal health records used in the study were de-identified to preserve confidentiality.
The researchers utilized several data analysis methods to identify and present their findings. First of all, they fit linear mixed effects regression models to examine associations of any antibiotics during pregnancy with BMI values at 5-year age (Heerman et al., 2019). In addition, the researchers adjusted those models for such extra variables as child ethnicity, sex, pregnancy smoking stats, and many others (Heerman et al., 2019). Finally, they created a set of regression models that included separate assessments of narrow and broad-spectrum antibiotic exposure during pregnancy (Heerman et al., 2019). The results were presented to the reader in the tables with β coefficients — or degree of association between a particular factor and the childhood obesity risk.
Overall, the main finding of the research was the absence of evident correlation between maternal antibiotic use and childhood obesity at the age of 5 years. The researchers managed to confirm that the dependent variable of a child’s BMI is much more significantly affected by smoking and diabetes than the use of antibiotics. Moreover, they did it in relation to a research sample of over 50,000 mother-child pairs, which added extra validity to their conclusions.
Summary/Conclusions, Implications, and Recommendations
In conclusion, the main strength of this study design lies in its clarity for competent scholars and nursing professionals since the authors thoroughly explained all quantitative tools utilized in their work. As a result, this research has a decent potential for being generalized over the population samples in other regions of the world. However, insufficient development of EHR technology in particular countries may pose a significant obstacle and hinder the process of data gathering. Nevertheless, the massive scope of research by Heerman et al. is important for nursing practice in general and my nursing practice. In the end, the knowledge that maternal antibiotic use has no impact on childhood obesity makes antibiotic prescribing for pregnant women significantly easier.
Heerman, W. J., Daley, M. F., Boone-Heinonen, J., Rifas-Shiman, S. L., Bailey, L. C., Forrest, C. B., Young, J. G., Gillman, M. W., Horgan, C. E., Janicke, D. M., Jenter, C., Kharbanda, E, O., Lunsford, D., Messito, M. J., Toh, S., & Block, J. P. (2019). Maternal antibiotic use during pregnancy and childhood obesity at age 5 years. International Journal of Obesity, 43(6), 1202-1209. Web.
Mor, A., Antonsen, S., Kahlert, J., Holsteen, V., Jørgensen, S., Holm-Pedersen, J., Sørensen, H. T., Pedersen, O., & Ehrenstein, V. (2015). Prenatal exposure to systemic antibacterials and overweight and obesity in Danish schoolchildren: a prevalence study. International Journal of Obesity, 39(10), 1450-1455. Web.
Poulsen, M. N., Pollak, J., Bailey‐Davis, L., Hirsch, A. G., Glass, T. A., & Schwartz, B. S. (2017). Associations of prenatal and childhood antibiotic use with child body mass index at age 3 years. Obesity, 25(2), 438-444. Web.