The safety of nitrofurantoin during the first trimester of pregnancy: meta‐analysis

David, Sholto; Einarson, Thomas R.; David, Yaacov Ben; Nulman, Irena; Pastuszak, Anne; Koren, Gideon

doi:10.1111/j.1472-8206.1995.tb00525.x

Cited by 38 publications

(22 citation statements)

References 22 publications

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“…Investigations have shown that addition of folic acid may prevent neural tube defects and urinary tract defects [21,22]. Other antimicrobial drugs used for urinary tract infection such as nitrofurantoin were not associated with either urinary tract or other defects [23,24].…”

Section: Discussionmentioning

confidence: 99%

Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations

Matok¹,

Gorodischer²,

Koren

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Previous studies have suggested a tendency of antifolate drugs to be associated with higher rates of neural tube defects. WHAT THIS STUDY ADDS• This study makes use of the data on abortuses, which is missed in many other studies. In this case, the abortion data were critical.• The study documents that clinicians should avoid, as much as possible, the use of folic acid antagonists during the first trimester of pregnancy, when embryogenesis takes place. AIMTo investigate the safety of folic acid antagonists during the first trimester of pregnancy in a large cohort. METHODSComputerized databases for medications dispensed from 1998 to 2007 to women registered in 'Clalit' HMO, Israel southern district, was linked with maternal and infant hospitalization records, and to therapeutics abortions data. The risk for adverse pregnancy outcomes of folic acid antagonists exposure was assessed by adjusting for known confounders. RESULTSEighty-four thousand, eight hundred and twenty-three infants were born and 998 therapeutic abortions took place; 571 fetuses and infants were exposed to one or more folic acid antagonists in the first trimester of pregnancy. Exposure was associated with an overall increased risk of congenital malformations [odds ratio (OR) 2.43, 95% confidence interval (CI) 1.92, 3.08], due mainly to increased risk for neural tube (adjusted OR 6.5, 95% CI 4.34, 9.15) and cardiovascular defects (OR 1.76, CI 1.05, 2.95). CONCLUSIONFirst-trimester exposure to folic acid antagonists is associated with increased risk of congenital malformations.

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Section: Discussionmentioning

confidence: 99%

Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations

Matok¹,

Gorodischer²,

Koren

et al. 2009

Brit J Clinical Pharma

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“…at ASPET Journals on May 11, 2018 dmd.aspetjournals.org Downloaded from studies have not shown side effects of fetal exposure of this drug (Prytherch et al, 1984), and human studies with a relatively small amount of data did not show evidence of harmful effects of NFT to the fetus Ben David et al, 1995), adverse effects related to the fetal exposure of NFT have recently been suggested. For example, there is evidence that links craniosynostosis to fetal exposure to NFT and drugs with similar chemical structures (Gardner et al, 1998;Källén and Robert-Gnansia, 2005).…”

Section: Bcrp and Fetal Distribution Of Nitrofurantoinmentioning

confidence: 99%

Breast Cancer Resistance Protein 1 Limits Fetal Distribution of Nitrofurantoin in the Pregnant Mouse

Zhang¹,

Wang²,

Unadkat³

et al. 2007

Drug Metabolism and Disposition

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ABSTRACT:The efflux transporter, the breast cancer resistance protein (BCRP), is most abundantly expressed in the apical membrane of the placental syncytiotrophoblasts, indicating that it could play an important role in protecting the fetus by limiting xenobiotic/drug penetration across the placental barrier. In the present study, we examined whether Bcrp1, the murine homolog of human BCRP, . These results clearly suggest that Bcrp1 significantly limits fetal distribution of NFT in the pregnant mouse, but has only a minor effect on the systemic clearance of the drug.

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“…The authors concluded because of the lack of good quality primary data and appropriate sample size, and therefore power, it is not possible to draw reliable conclusions on what is the best class, route or regimen of antibiotics to treat symptomatic urinary tract infections during pregnancy. One meta-analysis of four trials reported a non significant pooled odds ratio of any fetal malformation with nitrofurantoin of 1·29 (95% CI 0·25-6·57), although the number and quality of the studies included are limited [80]. There is a low level of resistance to nitrofurantoin among uropathogens with NCCLS data from 2000 reporting only a rate of 1% [81].…”

Section: Treatmentmentioning

confidence: 99%

Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy

Schnarr

Smaill

2008

Eur J Clin Investigation

270

255

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Symptomatic and asymptomatic bacteriuria is common in pregnant women. A history of previous urinary tract infections and low socioeconomic status are risk factors for bacteriuria in pregnancy. Escherichia coli is the most common aetiologic agent in both symptomatic and asymptomatic infection and quantitative culture is the gold standard for diagnosis. Treatment of asymptomatic bacteriuria has been shown to reduce the rate of pyelonephritis in pregnancy and therefore screening for and treatment of asymptomatic bacteriuria has become a standard of obstetrical care. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of low birth weight, but the methodological quality of the studies limits the strength of the conclusions that can be drawn. Debate exists in the literature as to whether treated pyelonephritis is associated with adverse fetal outcomes. There is no clear consensus in the literature on antibiotic choice or duration of therapy for infection. With increasing antibiotic resistance, consideration of local resistance rates is necessary when choosing therapy.

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The safety of nitrofurantoin during the first trimester of pregnancy: meta‐analysis

Cited by 38 publications

References 22 publications

Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations

Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations

Breast Cancer Resistance Protein 1 Limits Fetal Distribution of Nitrofurantoin in the Pregnant Mouse

Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy

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