Antibiotic use during pregnancy and the risk of preterm birth: a population-based Swedish cohort study

Abstract

Objectives To assess the impact of gestational antibiotics on the risk of preterm birth, since a healthy maternal microbiome may be protective. Methods Population-based cohort study including all first pregnancies in Sweden (2006–16). The association between gestational and recent pre-conception systemic antibiotics and preterm birth was assessed by multivariable logistic regression presented as ORs and 95% CIs, adjusted for comorbidities (hypo- and hyperthyroidism, hypertension, or diabetes mellitus pre-gestation), trimester, antibiotic class and treatment duration. Results Compared with non-users, antibiotic exposure was associated with increased risks of preterm birth in mothers with comorbidities (OR = 1.32, 95% CI 1.18–1.48) and without (OR = 1.09, 95% CI 1.06–1.13). Pre-conception use showed no association, while risk was increased for first and second trimester use and decreased for third trimester use. The increased risks were seen for the following antibiotic groups in mothers without and with comorbidities, respectively: macrolides, lincosamides and streptogramins (OR = 1.63, 95% CI 1.45–1.83; OR = 2.48, 95% CI 1.72–3.56); quinolones (OR = 1.60, 95% CI 1.32–1.94; OR = 2.11, 95% CI 1.12–4.03); non-penicillin β-lactams (OR = 1.15, 95% CI 1.07–1.24; OR = 1.39, 95% CI 1.07–1.83); other antibacterials (OR = 1.09, 95% CI 1.03–1.14; 1.38, 95% CI 1.16–1.63); and penicillins (OR = 1.04, 95% CI 1.01–1.08; 1.23, 95% CI 1.09–1.40). Antibiotic indications were not available, which could also affect preterm birth. Conclusions Antibiotic use during pregnancy was associated with an increased risk of preterm birth, especially in mothers with chronic diseases.

Maternal and Early-Life Exposure to Antibiotics and the Risk of Autism and Attention-Deficit Hyperactivity Disorder in Childhood: a Swedish Population-Based Cohort Study

“…The unique Swedish personal identification number allowed for a valid data linkage across the Medical Birth Registry, Causes of Death Registry, Swedish Prescribed Drug Registry, and the National Patient Registry (inpatient and specialist outpatient care) [ 18 ]. This cohort has previously been described in more detail [ 19 , 20 ], and was approved by the Regional Ethics Committee of Stockholm (2017/2423–31), which waived the need for informed consent because of the registry-nature of the data. The study accords to European General Data Protection Regulations, and the Declaration of Helsinki.…”

“…The last menstrual period date was calculated by extracting the gestational age (as dated at ultrasound, from embryo transfer or last menstrual period) from the date of birth. As the date of birth was provided in year/month format due to privacy regulations, it was set as the 15th of each month in all the observations [ 29 , 30 ]. Early-life exposure was defined as having received ≥ 1 dispensed antibiotic from birth until 2 years of age, ensuring that exposure occurred prior to the diagnosis of the outcome; and the first 2 years of life are regarded as being the most critical in the formation of a healthy microbiome [ 31 ].…”

Impact of Genital Infections and Antibiotic Use on Incidence of Preterm Birth: A Retrospective Observational Study

“…Nguyen et al’s study [ 39 ] provided a different perspective, assessing the impact of gestational antibiotic use on preterm birth risks. Their findings show an increased risk of preterm birth associated with antibiotic use during pregnancy, particularly in the first and second trimesters.…”

Population-based cohort study: proton pump inhibitor use during pregnancy in Sweden and the risk of maternal and neonatal adverse events

“…The study was performed using a Swedish cohort including all live singleton births delivered between July 2006 and December 2016, and the terminology "women" and "mother" were defined based on their biological sex and pregnancy status, not their gender identity. The cohort was created by linking information from four high-quality nationwide Swedish health data registries maintained by the National Board of Health and Welfare (Socialstyrelsen), as described earlier [21,22]: the Medical Birth Registry [23][24][25] (established in 1973), the Prescribed Drug Registry [26] (established in July 2005), the Patient Registry (in-and outpatient care) [27,28], and the Causes of Death Registry (since 1952). Information was linked through the unique Swedish personal identification number [29].…”