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Maternal antibiotic use linked to birth defects
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Pregnant women who take certain antibiotics are more likely to have children with digestive, cardiac or other potential adverse events, according to research published in British Journal of Clinical Pharmacology.
“Several studies have looked at the risk of major birth defect associated with the use of many antibiotics classes (macrolides, quinolones...) during pregnancy,” Flory T. Muanda, MD, of the pharmacy department at University of Montreal, and colleagues wrote. “Few studies have investigated the link between individual antibiotics and major congenital malformations, including specific malformations.”
For their cohort study, researchers looked at the relationship between antibiotic use in the mother’s first trimester and medical abnormalities among 15,469 live, singleton births through the child’s first year.
Researchers found that:
•clindamycin increased the likelihood for major congenital malformations (aOR = 1.34; 95% CI, 1.02-1.77), musculoskeletal system malformations (aOR = 1.67; 95% CI, 1.12-2.48) and ventricular/atrial septal defect (aOR = 1.81; 95% CI, 1.04-3.16);
•doxycycline increased the chances for cardiac malformations (aOR = 2.46; 95% CI, 1.21-4.99); circulatory system malformation (aOR = 2.38; 95% CI ,1.21-4.67) and ventricular/atrial septal defect (aOR = 3.19; 95% CI, 1.57-6.48);
•erythromycin increased the likelihood for urinary system malformations (aOR = 2.12, 95% CI, 1.08-4.17);
•macrolides increased the chances for digestive system malformations (aOR = 1.46, 95% CI,1.04-2.06);
•moxifloxacin increased the likelihood for respiratory system malformations (aOR = 5.48, 95% CI, 1.32-22.76);
•ofloxacin increased the chances for major congenital malformations (aOR = 8.3; 95% CI, 1.6-43);
•phenoxymethylpenicillin increased the likelihood for nervous system malformations (aOR = 1.85, 95% CI, 1.01-3.39); and
•quinolone exposure increased the chances for urinary system malformations (aOR = 1.89; 95% CI, 1.09-3.28).
Researchers reported no adverse events among women who used amoxicillin, cephalosporins, nitrofurantoin or penicillin.
According to Muanda and colleagues, these data reflect adjustments made for the mother’s educational level, marital status, age, ongoing medical condition, infections, use of health care systems and where she lived, as well as the year her baby was born and its sex.
Overall, researchers found that the antibiotic users in this study were more likely to have chronic conditions and infections, as well as use health care services, be welfare recipients and be less educated.
“To our knowledge, this is the largest cohort study investigating the risk of [major congenital malformations], including organ-specific malformations associated with the use of antibiotics classes and types during pregnancy,” Muanda and colleagues wrote. “Though the absolute risks for specific birth defects was small, physicians should consider prescribing safer antibiotics for the treatment of maternal infections when possible until more data are available.” – by Janel Miller
Disclosure: Muanda reports no relevant financial disclosures. Please see the study for a list of the other researchers’ relevant disclosures.
Perspective
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Alison G. Cahill, MD
I think that the study is interesting, and the questions it asks about medications and medication safety — and the impact they might have on pregnancy outcomes — are important ones that, as a high-risk obstetrician, I deal with daily.
This specific study is questioning whether early exposure to a variety of antibiotics increases the chance for malformations of the baby. The researchers highlight why this is an important question. The findings are certainly interesting, but it’s important to take these findings into account within the context of the larger literature on the topic. Although these researchers found a few pieces of information that raise the question as to whether one or more antibiotics may carry some risk, there are certainly studies in the literature that would say that antibiotics do not [carry risk].
I don’t think this study will change my practice or should change counseling to patients at this juncture. I think we are in the same spot that we are always in. Taking medications during pregnancy has important considerations. [Specifically,] it’s important for women to be appropriately treated for things like infections, which are typically treated with the antibiotics that this study examines. Also, what are the possible risks for using these antibiotics? That’s something that patients should always plan to discuss with their obstetric providers.
Perspective
Back to TopDouglas S. Paauw, MD, MACP
As physicians, we have to always weigh the risks vs. the benefits of any medication we prescribe. When we prescribe for pregnant women, there are additional risks that we have to take into account.
This study gives some information on the potential risk of use of antibiotics during pregnancy. It is reassuring that the use of penicillins and cephalosporins were not associated with major congenital malformations, as these drugs have long been considered to be the safest antibiotic options for pregnant women. Quinolones and tetracyclines are generally avoided during pregnancy because of known concern for cartilage formation (quinolones) and teeth discoloration (tetracyclines). In this study, clindamycin had an increased risk for major congenital malformations. Prescribers should be wary of clindamycin in the pregnant patient because of poor tolerability and Clostridium difficile risk. This study adds another reason to avoid clindamycin.
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