Gender differences in smartphone addiction, physical activity, and quality of life: a cross-sectional study.

Serious infections are a common cause of morbidity and mortality in children worldwide, imposing significant healthcare challenges even in developed countries []. Infections, such as sepsis, acute bronchiolitis, pneumonia, gastroenteritis, and pyelonephritis, contribute substantially to pediatric hospitalizations, emergency department visits, and healthcare expenditures, emphasizing the importance of identifying modifiable risk factors to mitigate infection-related burdens []. Beyond well-recognized risk factors, such as prematurity and immunodeficiency, growing attention has turned to the potential role of prenatal and childhood exposure to medications that may inadvertently heighten susceptibility to infections in children by disrupting immunological or physiological defenses [, ]. For managing gastroesophageal reflux symptoms in pregnant women, antacids such as calcium carbonate are typically used as first-line therapy. Acid-suppressive medications (ASMs), including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are commonly prescribed for individuals who do not respond to antacids, including pregnant women and children [–]. Although effective in reducing gastric acidity, these medications may attenuate host defense mechanisms against ingested pathogens by altering the gut microbiota, impairing immune cell function, and disrupting the gut-lung axis, and potentially increasing the risk of enteric, respiratory and even systemic infections [, –]. Emerging evidence links ASM to increased risk of infection, respiratory tract infections, urinary tract infections, skin infections, and even central nervous system infections [–]. However, these findings remain inconsistent, and the long-term effects of ASM exposure during critical developmental windows, particularly the prenatal period, remain unexplored. Recently, Lassalle et al. have reported an increased risk of serious infections with PPI use in young children [], yet no study to date has examined the impact of maternal ASMs use during pregnancy on childhood infection risk. This represents a critical knowledge gap, as the prenatal period is pivotal for immune system maturation which could be disrupted by ASM use during pregnancy. Understanding the associations is essential for guiding evidence-based prescribing practices and mitigating preventable health risks. This study attempted to address this research gap by investigating the associations between prenatal and/or childhood exposure to ASMs and the risk of serious infections in children in a nationwide cohort study using the entire National Health Insurance Research Database (NHIRD) in Taiwan.