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 Compared to women prescribed penicillin during their first
trimester, mothers given antibiotics in the macrolide class - which
has already been tied to miscarriages - were 55% more likely to have
a baby with major birth defects, the study found.
"Macrolides are frequently prescribed in pregnancy, and our findings
suggest it would be better to avoid macrolides during pregnancy if
alternative antibiotics can be used," said study leader Heng Fan of
University College London.
Many pregnant women who are allergic to penicillin are prescribed
macrolides for bacterial infections, researchers note in The BMJ.
Fan's team examined data on 104,605 children born from 1990 to 2016
whose mothers were prescribed penicillin or macrolides during
pregnancy.
Overall, 186 children born to mothers prescribed macrolides at any
point in pregnancy had major birth defects, including malformations
of the brain and nervous system, heart and lungs, digestive tract,
genitals or urinary tract. That translates into a birth defect rate
of 28 out of every 1,000 babies.
Most women in the study were prescribed penicillin. Among these
mothers, 1,666 children had major birth defects, or 18 per 1,000
babies.
Macrolides taken during the first trimester were tied to a higher
risk of cardiovascular malformations, with a birth defect rate of 11
out of 1,000 babies, compared with 7 in 1,000 babies for penicillin.
Use of erythromycin during the first trimester was linked to a 27
per 1,000 rate of major malformations, versus 18 per 1,000 with
penicillin.
Macrolide use during any trimester was also linked to a genital
malformations rate of 5 per 1,000 versus 3 per 1,000 with
penicillin.
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Although the risk of major birth defects is higher with macrolides, the risk is
still quite low and should be balanced against the even more serious problems
that can develop for babies whose mothers have untreated bacterial infections
during pregnancy, Fan said by email.
Uterine infections - one use for antibiotics during pregnancy - can damage the
placenta, contribute to premature labor and also lead to birth defects, for
example. These infections can also make labor more difficult and dangerous for
mothers and babies.
Rather than avoid antibiotics, pregnant women should use penicillin unless they
have a confirmed allergy, Fan said. Macrolides should be used with caution, and
only when penicillin isn't an option.
Along with to birth defects, researchers also looked for connections between
antibiotics and cerebral palsy, epilepsy, attention deficit hyperactivity
disorder (ADHD) and autism but found no links.
The study wasn't designed to prove whether or how certain antibiotics might
directly cause birth defects.
Still, it adds to evidence suggesting that macrolides should be avoided as much
as possible during pregnancy, said Anick Berard of CHU Sainte-Justine and the
University of Montreal.
"Given that infections need to be treated during pregnancy, I suggest
less-problematic antibiotics use like penicillin or amoxicillin," Berard, who
wasn't involved in the study, said by email. "These molecules are safe."
This may be easier said than done if more bacteria develop that are resistant to
treatment with penicillin, Berard noted.
SOURCE: https://bit.ly/2v4eU1U The BMJ, online February 19, 2020.
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