Is metronidazole teratogenic? A meta‐analysis

T, Caro-Patón; Carvajal, Alfonso; Diego, Isaac Martín de; Martin-Arias, Luis; Requejo, Ana Alvarez; Pinilla, Elvira Rodríguez

doi:10.1046/j.1365-2125.1997.00660.x

Cited by 183 publications

(72 citation statements)

References 9 publications

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“…95 The epidemiological data regarding maternal vaginal metronidazole (FDA category B) use early in pregnancy were summarized in 2 meta-analyses. 96,97 In both instances, the risk of congenital anomalies in offspring was not increased. One of the studies included in these analyses specifically examined a large group (984) of infants with cardiovascular defects.…”

Section: Vitamin a Cogeners/retinoidsmentioning

confidence: 88%

Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge

Jenkins¹,

Correa²,

Feinstein³

et al. 2007

Circulation

711

336

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Abstract-Prevention of congenital cardiovascular defects has been hampered by a lack of information about modifiable risk factors for abnormalities in cardiac development. Over the past decade, there have been major breakthroughs in the understanding of inherited causes of congenital heart disease, including the identification of specific genetic abnormalities for some types of malformations. Although relatively less information has been available on noninherited modifiable factors that may have an adverse effect on the fetal heart, there is a growing body of epidemiological literature on this topic. This statement summarizes the currently available literature on potential fetal exposures that might alter risk for cardiovascular defects. Information is summarized for periconceptional multivitamin or folic acid intake, which may reduce the risk of cardiac disease in the fetus, and for additional types of potential exposures that may increase the risk, including maternal illnesses, maternal therapeutic and nontherapeutic drug exposures, environmental exposures, and paternal exposures. Information is highlighted regarding definitive risk factors such as maternal rubella; phenylketonuria; pregestational diabetes; exposure to thalidomide, vitamin A cogeners, or retinoids; and indomethacin tocolysis. Caveats regarding interpretation of possible exposure-outcome relationships from case-control studies are given because this type of study has provided most of the available information. Guidelines for prospective parents that could reduce the likelihood that their child will have a major cardiac malformation are given. Issues related to pregnancy monitoring are discussed. Knowledge gaps and future sources of new information on risk factors are described.

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Section: Vitamin a Cogeners/retinoidsmentioning

confidence: 88%

Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge

Jenkins¹,

Correa²,

Feinstein³

et al. 2007

Circulation

711

336

View full text Add to dashboard Cite

show abstract

“…The Food and Drug Administration (FDA) classified metronidazole as a class B risk factor for pregnancy. Accordingly, use of metronidazole for amoebiasis in pregnant women is not currently recommended (58,59), although a causal connection between metronidazole exposure during pregnancy and birth defects has not been established (45,63,94). Emetine and dehydroemetine hydrochloride have serious side effects, including nausea, vomiting, cardiotoxicity, local pain, and tenderness (162).…”

Section: Current Chemotherapeutics Current Chemotherapeutics For E Hmentioning

confidence: 99%

Current Therapeutics, Their Problems, and Sulfur-Containing-Amino-Acid Metabolism as a Novel Target against Infections by “Amitochondriate” Protozoan Parasites

2007

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SUMMARY The “amitochondriate” protozoan parasites of humans Entamoeba histolytica, Giardia intestinalis, and Trichomonas vaginalis share many biochemical features, e.g., energy and amino acid metabolism, a spectrum of drugs for their treatment, and the occurrence of drug resistance. These parasites possess metabolic pathways that are divergent from those of their mammalian hosts and are often considered to be good targets for drug development. Sulfur-containing-amino-acid metabolism represents one such divergent metabolic pathway, namely, the cysteine biosynthetic pathway and methionine γ-lyase-mediated catabolism of sulfur-containing amino acids, which are present in T. vaginalis and E. histolytica but absent in G. intestinalis. These pathways are potentially exploitable for development of drugs against amoebiasis and trichomoniasis. For instance, l-trifluoromethionine, which is catalyzed by methionine γ-lyase and produces a toxic product, is effective against T. vaginalis and E. histolytica parasites in vitro and in vivo and may represent a good lead compound. In this review, we summarize the biology of these microaerophilic parasites, their clinical manifestation and epidemiology of disease, chemotherapeutics, the modes of action of representative drugs, and problems related to these drugs, including drug resistance. We further discuss our approach to exploit unique sulfur-containing-amino-acid metabolism, focusing on development of drugs against E. histolytica.

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“…36 Multiple studies and meta-analyses have concluded that metronidazole does not appear to be associated with an increased teratogenic risk. [37][38][39] However, two studies have suggested that treatment with metronidazole in women with TV can increase preterm birth. 40,41 This adverse effect has been difficult to explain, but raises a caution about the unnecessary use of metronidazole in pregnancy.…”

Section: Adherence To the Syndromic Management Treatment Guidelinesmentioning

confidence: 99%

Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach

Romøren

Velauthapillai

Rahman³

et al. 2007

Bull World Health Organ

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Objective To measure the prevalence of Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) among pregnant women in Botswana, and to evaluate the syndromic approach and alternative management strategies for these conditions in pregnancy. Methods In a cross-sectional study, 703 antenatal care attendees were interviewed and examined, and specimens were collected to identify TV, BV, Candida species, Chlamydia trachomatis and Neisseria gonorrhoeae. Information on reproductive tract infections earlier in pregnancy was obtained from a structured interview and the antenatal record. Findings TV was found in 19% and BV in 38% of the attendees. Three-fourths of women with TV or BV were asymptomatic. Syndromic management according to the vaginal discharge algorithm would lead to substantial under-diagnosis and over-treatment of TV and BV. Signs of vaginal discharge were more predictive of the presence of these conditions than were symptoms. Among the 546 attendees on a repeat antenatal visit, 142 (26%) had been diagnosed with vaginal discharge earlier in their pregnancy -14 of them twice. In 143 cases, an attendee was diagnosed with vaginal discharge in the second or third trimester; however, metronidazole had been prescribed only 17 times (12%). Conclusion Diagnosis and treatment of TV and BV among pregnant women in sub-Saharan Africa presents major challenges. Half the pregnant women in this study were diagnosed with TV or BV, but these conditions were not detected and treated during antenatal care with syndromic management. Also, health workers did not adhere to treatment guidelines. These results indicate that management guidelines for TV and BV in antenatal care should be revised.

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Is metronidazole teratogenic? A meta‐analysis

Cited by 183 publications

References 9 publications

Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge

Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge

Current Therapeutics, Their Problems, and Sulfur-Containing-Amino-Acid Metabolism as a Novel Target against Infections by “Amitochondriate” Protozoan Parasites

Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach

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