The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

Abstract

BackgroundThe association between macrolides use and subsequent occurrence of infantile hypertrophic pyloric stenosis (IHPS) is still debatable. The aim of this study was to conduct a systematic review and meta-analysis of the association between perinatal exposure to macrolides, mainly erythromycin, and the development of pyloric stenosis.MethodsOriginal studies were identified using MEDLINE, Web of Science, Scopus, Google Scholar, and the Cochrane Library databases. Studies investigating the association between perinatal exposure to macrolides and pyloric stenosis were included. The most adjusted effect estimates were pooled using random-effects meta-analysis. The I2 and Egger’s tests were used to assess heterogeneity and publication bias, respectively.ResultsFourteen papers (12 retrospective cohort studies and two case-control studies) were included. For postnatal exposure, the overall estimate of seven cohort studies indicated a statistically significant association (RR = 3.17, 95% CI: 2.38–4.23; I2 = 10.0%) with no evidence of publication bias (Egger P = 0.81). For prenatal exposure, six cohort studies and two case-control studies were included. Meta-analysis demonstrated a statistically significant association in the cohort studies (OR = 1.47, 95% CI: 1.03–2.09; I2 = 29.3%), but not in the case-control studies (OR = 1.02, 95% CI: 0.66–1.58; I2 = 51.2%). The overall pooled result was not statistically significant. Only two studies were included for exposure through breastfeeding, and the estimates did not show a statistically significant association (OR = 1.31; 95% CI: 0.42–4.1; I2 = 69.1%).ConclusionsThe study demonstrated good evidence of association between development of IHPS and direct postnatal exposure to macrolides. However, the evidence on the effects of prenatal exposure or postnatal maternal exposure (breastfeeding) is not conclusive.

Interactions of Bacteriophages with Animal and Human Organisms—Safety Issues in the Light of Phage Therapy

“…Pregnancy is a stage in female life where various physiological changes occur, and it results in a number of risks in relation to pharmacokinetics of different therapeutics [220,221]. The use of some medicines, including antibiotics, may also pose a risk to developing fetus [222,223]. Therefore, the use of phage therapy, which is generally considered safer than the use of antibiotics and lacking serious side effects, may be an attractive alternative for treating uterine infections as well as other diseases during pregnancy [216].…”

Use of Azithromycin in Pregnancy: More Doubts than Certainties

“…In 2019, two separate systematic reviews and meta-analyses evaluated the association of prenatal and postnatal macrolide exposure with subsequent development of IHPS. In the first review, Abdellatif et al [ 83 ] found no significant association between macrolide use during pregnancy and development of IHPS, while the evidence on the effects of prenatal macrolide exposure was not conclusive in the second review [ 84 ].…”

Estenosis hipertrófica del píloro pediátrica

“…Ha demostrado tener una fuerte agregación familiar. Los hermanos de pacientes con EHP tienen de 15 a 30 veces más riesgo de padecer esta enfermedad y afecta al 50% de los gemelos idénticos (8). Se ha sugerido en términos generales una herencia autosómica, pero no hay un gen específico identificado que sea responsable de dicha enfermedad (9).…”

“…Un factor de riesgo ambiental sospechado es la exposición a macrólidos, principalmente a la eritromicina, en la etapa prenatal. Sin embargo, la evidencia que respalda esta asociación sigue siendo elusiva (5,8). Además, se ha observado también una relación con la exposición prenatal a Talidomida, Hidantoina, Trimetadiona, pesticidas agrícolas y a la administración de fórmulas lácteas hiperosmolares (9).…”