Use of Azithromycin in Pregnancy: More Doubts than Certainties

Antonucci, Roberto; Cuzzolin, Laura; Locci, Cristian; Dessole, Francesco; Capobianco, Giampiero

doi:10.1007/s40261-022-01203-0

Cited by 11 publications

(7 citation statements)

References 83 publications

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“…Increased risk of major congenital malformations, spontaneous abortions, gastrointestinal malformations, cardiovascular malformations, preterm delivery, and low birth weight have been reported in several studies [ 32 – 37 ] of fetal and neonatal outcomes following prenatal azithromycin exposure. However, There is no established evidence to support the use of azithromycin in pregnant women with adverse consequences for their offspring [ 38 ]. Therefore, although azithromycin may have potential benefits for maternal health, its impact on neonatal outcomes remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

Ye,

Hu,

et al. 2024

BMC Pregnancy Childbirth

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Objective This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns. Data sources We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024. Methods We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity. Results The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55–0.77; I2, 0%; P < .00001); 0.62 for endometritis (95% CI, 0.52–0.74; I2, 2%; P < .00001); and 0.43 for maternal wound or surgical site infection (95% CI, 0.24–0.78; P < .005); however, there was great heterogeneity among the studies (I2, 75%). The pooled OR for pyelonephritis and urinary tract infections was 0.3 (95% CI, 0.17–0.52; I2, 0%; P < .0001), and that for neonatal skin infections was 0.48 (95% CI, 0.35–0.65; I2, 0%, P < .00001). There was no significant difference in maternal all-cause mortality or incidence of chorioamnionitis between the two groups. No significant differences were observed in the incidence of neonatal sepsis or suspected sepsis, all-cause mortality, or infections of the eyes or ears. Conclusion In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections. These findings indicate that azithromycin may be potentially beneficial for maternal postpartum infections, but its effect on neonatal prognosis remains unclear. Azithromycin should be used antenatally only if the clinical indication is clear and the potential benefits outweigh the harms.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, although azithromycin may have potential benefits for maternal health, its impact on neonatal outcomes remains unclear. If the expected therapeutic benefit outweighs the potential risk, the drug should be used during pregnancy only if clinically indicated [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

Ye,

Hu,

et al. 2024

BMC Pregnancy Childbirth

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“…Macrolides such as azithromycin are commonly prescribed antibiotics during pregnancy. The good oral bioavailability and transplacental transfer (3%) of azithromycin make this drug suitable for treating sexually transmitted diseases, toxoplasmosis, and malaria ( Antonucci et al, 2022 ). However, the debates on the effects of administering azithromycin during pregnancy on offspring outcomes are ongoing.…”

Section: Association Between Prenatal Drug Exposure and Programmed Ca...mentioning

confidence: 99%

The molecular mechanisms in prenatal drug exposure-induced fetal programmed adult cardiovascular disease

Zhou

Hua

et al. 2023

Front. Pharmacol.

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The “developmental origins of health and disease” (DOHaD) hypothesis posits that early-life environmental exposures have a lasting impact on individual’s health and permanently shape growth, structure, and metabolism. This reprogramming, which results from fetal stress, is believed to contribute to the development of adulthood cardiovascular diseases such as hypertension, coronary artery disease, heart failure, and increased susceptibility to ischemic injuries. Recent studies have shown that prenatal exposure to drugs, such as glucocorticoids, antibiotics, antidepressants, antiepileptics, and other toxins, increases the risk of adult-onset cardiovascular diseases. In addition, observational and animal experimental studies have demonstrated the association between prenatal drug exposure and the programming of cardiovascular disease in the offspring. The molecular mechanisms underlying these effects are still being explored but are thought to involve metabolism dysregulation. This review summarizes the current evidence on the relationship between prenatal drug exposure and the risk of adult cardiovascular disorders. Additionally, we present the latest insights into the molecular mechanisms that lead to programmed cardiovascular phenotypes after prenatal drug exposure.

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“…Although the benefits of rational antibiotic use are evident, pregnancy and the lactating period are critical windows during which maternal intake often exposes the fetus and offspring to drugs transmitted via the placenta and breast milk. Even if penicillins are considered safe and are most frequently prescribed during pregnancy in many countries, 4,10,11 concerns regarding the potential use of other antibiotics with less certain safety profiles such as macrolides, sulfonamides and quinolones remain 15,16 . Furthermore, widespread use of antibiotics in perinatal care can ultimately contribute to the development and spread of antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

“…Even if penicillins are considered safe and are most frequently prescribed during pregnancy in many countries, 4 , 10 , 11 concerns regarding the potential use of other antibiotics with less certain safety profiles such as macrolides, sulfonamides and quinolones remain. 15 , 16 Furthermore, widespread use of antibiotics in perinatal care can ultimately contribute to the development and spread of antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic use during pregnancy in Sweden: A nationwide utilization study covering 2007–2019

Nakitanda,

Odsbu,

Pasternak

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionAntibiotics are often prescribed during pregnancy. Assessing the current state of prenatal antibiotic use is therefore imperative for optimizing prescribing and identifying emerging research priorities. The study aimed to describe recent trends and patterns in antibiotic use during pregnancy among women who gave birth in Sweden, including user characteristics.Material and methodsPopulation‐based descriptive study using linked nationwide registers. All pregnancies delivered in Sweden from 2007 to 2019 were included. Prevalence of use was defined as the percentage of pregnancies during which at least one prescription forantibiotics was filled. Temporal trends in the prevalence of antibiotic use by calendar year, trimester and weeks of gestation were assessed from time series graphs.ResultsPrescriptions for systemic antibiotics were filled in 20.7% of 1 434 431 pregnancies overall, decreasing from 24.7% in 2007 to 18.0% in 2019. Phenoxymethylpenicillin (8.5%), pivmecillinam (6.5%), nitrofurantoin (4.7%), amoxicillin (1.6%) and cefadroxil (1.5%) use were the most prevalent. Their use decreased over the 13‐year period, except for pivmecillinam, which increased from 4.0% to 7.4%. Prevalence of use was highest in the second trimester (9.5%), with weekly trends peaking at 13 and 34 weeks of gestation. Compared with non‐users, antibiotic users more often belonged to the youngest and oldest age strata, carried multipleton pregnancies, had delivered before, had attained a lower education level and smoked in early pregnancy. A higher body mass index, asthma, chronic renal disease and diabetes mellitus were more prevalent among antibiotic users than among non‐users.ConclusionsAlthough outpatient antibiotic use during pregnancy in Sweden has been declining, one in five pregnancies was exposed to systemic antibiotics.

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Use of Azithromycin in Pregnancy: More Doubts than Certainties

Cited by 11 publications

References 83 publications

Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

The molecular mechanisms in prenatal drug exposure-induced fetal programmed adult cardiovascular disease

Antibiotic use during pregnancy in Sweden: A nationwide utilization study covering 2007–2019

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