Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study

Arch Pediatr Adolesc Med. 2009 Nov;163(11):978-85. doi: 10.1001/archpediatrics.2009.188.

Abstract

Objective: To estimate the association between antibacterial medications and selected birth defects.

Design, setting, and participants: Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941).

Main exposure: Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester).

Main outcome measure: Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders.

Results: The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect).

Conclusions: Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abnormalities, Drug-Induced / epidemiology*
  • Adolescent
  • Adult
  • Anencephaly / chemically induced
  • Anencephaly / epidemiology
  • Anophthalmos / chemically induced
  • Anophthalmos / epidemiology
  • Anti-Bacterial Agents / adverse effects*
  • Case-Control Studies
  • Cephalosporins / adverse effects
  • Choanal Atresia / chemically induced
  • Choanal Atresia / epidemiology
  • Cleft Lip / chemically induced
  • Cleft Lip / epidemiology
  • Cleft Palate / chemically induced
  • Cleft Palate / epidemiology
  • Erythromycin / adverse effects
  • Female
  • Heart Defects, Congenital / chemically induced
  • Heart Defects, Congenital / epidemiology
  • Hernia, Diaphragmatic / chemically induced
  • Hernia, Diaphragmatic / epidemiology
  • Humans
  • Limb Deformities, Congenital / chemically induced
  • Limb Deformities, Congenital / epidemiology
  • Microphthalmos / chemically induced
  • Microphthalmos / epidemiology
  • Middle Aged
  • Nitrofurantoin / adverse effects
  • Penicillins / adverse effects
  • Population Surveillance
  • Pregnancy
  • Quinolones / adverse effects
  • Sulfonamides / adverse effects
  • Tetracyclines / adverse effects
  • United States / epidemiology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Penicillins
  • Quinolones
  • Sulfonamides
  • Tetracyclines
  • Erythromycin
  • Nitrofurantoin