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

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

Author information

  • 1Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. kcrider@cdc.gov

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.

Comment in

PMID:
19884587
[PubMed - indexed for MEDLINE]
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