Azithromycin has not been associated with an increased risk of malformations in animal studies 7. It has been shown to have a relatively low rate of in vitro transplacental passage 2.
To date, the majority of observational studies suggested no significant associations between prenatal azithromycin use and major congenital malformations However, a trend towards increase in the rate of malformations was also seen in a few studies.
An important recent cohort study by Damkier et al. The authors reported a small yet statistically significant increase in risk of major congenital malformations OR 1. However when exposed women were compared to penicillin exposed women disease match controls the point estimates for both outcomes decreased and the OR for major malformations became non-significant MCM: OR 1. To date, there are also four meta-analyses investigating major malformations following macrolide exposure during pregnancy , which have used different methodology and reported inconsistent findings.
Among those, the meta-analysis by Fan et al. Recent preliminary findings from a meta-analysis by our team detected, similar to Damkier et al, a slight yet significant increase in risk of major congenital malformations OR 1. The OR for the risk of heart defects were non-significant OR 1.
However the contribution of maternal confounders could not be definitively ruled out. In another meta-analysis, the pooled data of two cohort studies have not shown a significantly increased risk for major congenital malformation or heart defects following prenatal azithromycin exposure ORmix control group 1.
Other adverse pregnancy outcomes There is only one nested case-control study evaluating the rates of spontaneous abortions following azithromycin exposure, showing a moderate and significant increased risk aOR 1. Inconsistent results exist regarding the association of infantile hypertrophic pyloric stenosis IHPS following macrolide exposure, particularly erythromycin, during pregnancy 22, The study by Meeraus et al.
However, further data are needed before confirming these associations as causal since inconsistent findings, particularly for the association of prenatal antibiotic use and childhood asthma, exist. Furthermore, several confounders such as genetics, environmental and paternal exposures, infections and disruption of maternal microbiota should be better addressed. A key parameter for evaluating the safety of medications during breastfeeding is the Relative Infant Dose RID which is calculated by dividing the dose that the infant is exposed to via milk by the weight-adjusted dose of the mother.
Hale reported a RID of 5. Pharmacokinetic studies regarding the passage of azithromycin into breast milk and its' maternal levels were based on data of approximately 50 women who received single dose azithromycin mg or 2 g during labor In modelling studies it was predicted that the infant would be exposed to an average dose of 0. These levels are lower than the usual treatment doses for infants. According to the simulated a maternal dosage regimen, weight-adjusted dosage of azithromycin was found to be 2.
Azithromycin exposure during breastfeeding was noted in four studies. Further stratification of the infants yielded an OR of In addition, no information was given regarding the specific macrolide used by the affected infants Macrolide use in both infants and mothers during days 0 to 13 after birth was associated with IHPS in this study A single copy of these materials may be reprinted for noncommercial personal use only.
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See more conditions. Request Appointment. Healthy Lifestyle Pregnancy week by week. Products and services. Is it safe to take antibiotics during pregnancy? Answer From Mary Marnach, M. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Landon MB, et al.
Drugs and environmental agents in pregnancy and lactation: Teratology, epidemiology, and patient management. Clarithromycin is category C, which means it has been shown to have negative effects in animals.
Neither group has had well-controlled studies in humans. No matter what you and your doctor decide is the right course of action in the case of infection, communication is key. Speak with all of your healthcare providers about any medications you are taking to avoid drug interactions, and always tell or remind your healthcare provider that you are pregnant when receiving prescription medications or care.
You should also make your prescriber aware of any allergies or health conditions such as kidney disease, liver disease or a history of hepatitis or jaundice or mononucleosis , as all can determine which antibiotic is safest for you, Dr.
If you experience any side effects or if the infection is not clearing, you should also alert your prescribing physician. Antibiotics and Pregnancy. Aleisha Fetters June 11, Save Pin FB More. Viral infections should not be treated with antibiotics for two reasons:. It won't get rid of the infection. Overuse of antibiotics leads to drug-resistant bacteria, so when you need antibiotics, they might not work.
Preg antibiotics Some antibiotics commonly considered SAFE for use during pregnancy:. Aleisha Fetters. Comments 1. Bush MR, Rosa C: Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.
CAS Google Scholar. Miller JM: Recurrent Chlamydial colonization during pregnancy. Am J of Perinatology. Article Google Scholar. J Reprod Med. Br J Obstet Gynaecol. Ogasawara KK, Goodwin TM: Efficacy of azithromycin in reducing lower genital Ureaplasma urealyticum colonization in women at risk for preterm delivery.
J Matern Fetal Med. Clin Infect Dis. Holmes LB: Need for inclusion and exclusion criteria for the structural abnormalities recorded in children born from exposed pregnancies. Am J Perinatol. Effects of antibacterials on the unborn child: what is known and how should this influence prescribing. Paediatr Drugs. Inf dis Obstet Gynecol. Adimora AA: Treatment of uncomplicated genital Chlamydia trachomatis infections in adults.
Donders GG: Treatment of sexually transmitted bacterial diseases in pregnant women. Human Reproduction Update. Download references. We would like to acknowledge Julia Perstein and Natasha Pinto for their help with data collection for this study.
You can also search for this author in PubMed Google Scholar. Correspondence to Adrienne RN Einarson. MS conceived and designed the study, analysed the data and wrote the manuscript.
CW assisted in designing the study and editing the manuscript. GK edited the manuscript and assisted in the design of the study.
AE helped design study and write the paper. Reprints and Permissions. Sarkar, M. Pregnancy outcome following gestational exposure to azithromycin.
BMC Pregnancy Childbirth 6, 18 Download citation. Received : 03 February Accepted : 30 May Published : 30 May Anyone you share the following link with will be able to read this content:.
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