Use of antibiotics during pregnancy and risk of spontaneous abortion

Abstract

BACKGROUND: Although antibiotics are widely used during pregnancy, evidence regarding their fetal safety remains limited. Our aim was to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. METHODS:We conducted a nested case-control study within the Quebec Pregnancy Cohort (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009). We excluded planned abortions and pregnancies exposed to fetotoxic drugs. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. The index date was defined as the calendar date of the spontaneous abortion. Ten controls per case were randomly selected and matched by gestational age and year of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date and was compared with (a) non-exposure and (b) exposure to penicillins or cephalosporins. We studied type of antibiotics separately using the same comparator groups. RESULTS:After adjustment for potential confounders, use of azithromycin (adjusted odds ratio [OR] 1.65, 95% confidence interval [CI] 1.34-2.02; 110 exposed cases), clarithromycin (adjusted OR 2.35, 95% CI 1.90-2.91; 111 exposed cases), metronidazole (adjusted OR 1.70, 95% CI 1.27-2.26; 53 exposed cases), sulfonamides (adjusted OR 2.01, 95% CI 1.36-2.97; 30 exposed cases), tetracyclines (adjusted OR 2.59, 95% CI 1.97-3.41; 67 exposed cases) and quinolones (adjusted OR 2.72, 95% CI 2.27-3.27; 160 exposed cases) was associated with an increased risk of spontaneous abortion. Similar results were found when we used penicillins or cephalosporins as the comparator group. INTERPRETATION:After adjustment for potential confounders, use of macrolides (excluding erythromycin), quinolones, tetracyclines, sulfonamides and metronidazole during early pregnancy was associated with an increased risk of spontaneous abortion. Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy.

Drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia: Consideration of toxicological perspectives

“…During pregnancy, pharmacokinetic alterations in antibiotics require dose adjustment or careful monitoring and assessment [4, 23]. Antibiotic use during pregnancy has also shown a risk of spontaneous abortion and congenital malformations in the first trimester [24–27]. …”

Antibiotic Resistance in Modern World

“…Вот почему так важно диаду мать-дитя наблюдать бригадой спе-циалистов, включающей в обязательном порядке помимо акушера-гинеколога еще и педиатра, кото-рый не допустит назначения опасных для здоровья будущего человека антибиотиков без особых на то показаний! Кстати, есть данные и связи приема анти-биотиков с повышенным риском самопроизвольного выкидыша [22]. В своем исследовании канадские уче-ные из Монреальского университета, изучавшие данные о 182 369 беременных женщинах в возрасте 15-45 лет за период с 1998 по 2009 г., проживающих в провинции Квебек, установили, что применение антибиотиков уве-личивало риск самопроизвольных абортов: макролидов (азитромицина и кларитромицина) -на 67%, хинолонов, тетрациклинов, сульфаниламидов -на 65%, метронида-зола -на 70%.…”

The safety of quinolones and fluoroquinolones in pregnancy: a meta‐analysis

“…Several animal model studies have shown possible teratogenic effects. [14][15][16] In the present study we wished to further explore this topic by performing an updated literature search and metaanalysis of the human studies, and in this way provide practical guidance about the use of these agents in pregnancy. In 2009, Bar-Oz et al performed a meta-analysis of the available data regarding the effect of fluoroquinolones, taken during the first trimester, on fetal malformations and pregnancy outcomes.…”