Taking macrolide antibiotics in pregnancy may be linked to subsequent birth defects, researchers warned today.
A team of researchers from University College London, UK, compared macrolides with penicillin.
PhD student Heng Fan and colleagues analysed information on 104,605 children born in the UK from 1990 to 2016, followed to about six years of age. They also looked at 82,314 children whose mothers took macrolides or penicillin before pregnancy, and 53,735 of their siblings.
This showed that taking macrolides in the first trimester of pregnancy was linked to a raised risk of major malformation compared with penicillin (28 versus 18 per 1,000 births). The highest risk was for cardiovascular malformations (11 versus seven per 1,000 births).
Findings appear today in The BMJ. Ms Fan explains: “Macrolide antibiotics are used to treat a wide variety of bacterial infections and are among the most frequently prescribed antibiotics during pregnancy in Western countries.
“This work builds on previous evidence of rare but serious adverse outcomes of macrolide use, especially for unborn babies. These adverse outcomes were assumed to be associated with the arrhythmic effect of macrolides and policy advice about their use in pregnancy varies.”
She adds, “If the associations are shown to be causal, these findings suggest that an additional four children would be born with cardiovascular malformations for every 1,000 children exposed to macrolides instead of penicillins in the first trimester of pregnancy.”
The team suggests that it might be better to avoid macrolides during pregnancy if alternative antibiotics can be used.
Fan, H. et al. Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study. The BMJ 20 February 2020
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