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Use of antibiotics during pregnancy and risk of spontaneous abortion.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28461374
OWN - NLM
STAT- MEDLINE
DA  - 20170502
DCOM- 20170508
LR  - 20170511
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 17
DP  - 2017 May 01
TI  - Use of antibiotics during pregnancy and risk of spontaneous abortion.
PG  - E625-E633
LID - 10.1503/cmaj.161020 [doi]
AB  - 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 (1998-2009). 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 macro-lides (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.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Muanda, Flory T
AU  - Muanda FT
AD  - Faculty of Pharmacy (Muanda, Berard), Universite de Montreal; Research Center
      (Muanda, Sheehy, Berard), Centre hospitalier universitaire (CHU) Sainte-Justine, 
      Montreal, Que.
FAU - Sheehy, Odile
AU  - Sheehy O
AD  - Faculty of Pharmacy (Muanda, Berard), Universite de Montreal; Research Center
      (Muanda, Sheehy, Berard), Centre hospitalier universitaire (CHU) Sainte-Justine, 
      Montreal, Que.
FAU - Berard, Anick
AU  - Berard A
AD  - Faculty of Pharmacy (Muanda, Berard), Universite de Montreal; Research Center
      (Muanda, Sheehy, Berard), Centre hospitalier universitaire (CHU) Sainte-Justine, 
      Montreal, Que. [email protected]
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Macrolides)
RN  - 0 (Quinolones)
RN  - 0 (Sulfonamides)
RN  - 0 (Tetracyclines)
RN  - 140QMO216E (Metronidazole)
SB  - AIM
SB  - IM
MH  - Abortion, Spontaneous/chemically induced/*epidemiology
MH  - Adolescent
MH  - Adult
MH  - Anti-Bacterial Agents/*adverse effects
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Female
MH  - Gestational Age
MH  - Humans
MH  - Macrolides/adverse effects
MH  - Maternal Exposure/*adverse effects
MH  - Metronidazole/adverse effects
MH  - Odds Ratio
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/*drug therapy
MH  - Quebec
MH  - Quinolones/adverse effects
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sulfonamides/adverse effects
MH  - Tetracyclines/adverse effects
MH  - Young Adult
PMC - PMC5415390
COI - Competing interests: Anick Berard is a consultant for plaintiffs in litigations
      involving antidepressants and birth defects. No other competing interests were
      declared.
EDAT- 2017/05/04 06:00
MHDA- 2017/05/10 06:00
CRDT- 2017/05/03 06:00
PHST- 2017/01/09 [accepted]
AID - 189/17/E625 [pii]
AID - 10.1503/cmaj.161020 [doi]
PST - ppublish
SO  - CMAJ. 2017 May 1;189(17):E625-E633. doi: 10.1503/cmaj.161020.

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