Antibiotics in pregnancy

Antibiotics in pregnancy

In this week's news, it's been suggested that there is a link between antibiotic usage in pregnancy and the risk of infection in children. If you are expecting, you may have some concerns that we can help clarify.

A recently published Danish study has looked at the health outcomes of two groups of children—those whose mothers were prescribed antibiotics when pregnant and those who weren’t.

The study found that children whose mother was prescribed antibiotics prior to or during  were 20 per cent more likely to be admitted to hospital with an infection in childhood (up to 14 years of age) when compared to children whose mothers weren’t prescribed antibiotics.

Should we stop using antibiotics in pregnancy?

What this study has demonstrated is an association between antibiotic use in pregnancy and infections in childhood. But, this study has not (and can not) demonstrate causation. It doesn’t prove that the antibiotics themselves were the problem. 

The authors of the study acknowledge that there could be other factors at play—including maternal illness that prompts the antibiotic use and subsequently impacts on childhood health. Or there may be other shared genetic, social or environmental factors that contribute. 

What happens if we stop using antibiotics in pregnancy?

Pregnant women are generally more susceptible to infections than people who aren’t pregnant. This is because pregnancy causes a mild form of immunosuppression (or a weakened immune system). Some infections, like bladder and kidney infections, are more common in pregnancy and some infections tend to be more serious if contracted during pregnancy.

Infections in pregnancy generally aren’t a great thing. While some may be mild and resolve spontaneously, other more serious infections may be life-threatening for both mum and her unborn baby.

There are also a number of pregnancy complications that are known to be associated with, or sometimes caused by, infections in pregnancy. These can include pregnancy loss (miscarriage or stillbirth), preterm labour, preterm rupture of membranes and preterm birth. And from a maternal perspective there is potential for serious illness, multi organ failure and even death.

In these situations treatment with antibiotics can be crucial and even save two lives!

Antibiotic resistance is a real problem though. Bacteria are evolving and developing resistance to the antibiotics that we are using to try to control them and inappropriate use of antibiotics is contributing to this serious problem.

So any decision to prescribe antibiotics for a pregnant woman should involve careful consideration of the benefits (or harm) of treatment verses the risk of not treating the infection and the potential harm that may cause to mum and baby.

Are all antibiotics equally safe in pregnancy?

The simple answer to that is no.  There are some antibiotics that are best to avoid in pregnancy and others are okay towards the end of pregnancy but not early on (or vice versa). There are also some antibiotics which appear to be safe throughout pregnancy and into the postpartum period.

So, are antibiotics safe in pregnancy?

There is no doubt that in some situations antibiotic use in pregnancy is critical and lifesaving for mum, and may reduce the chances of serious pregnancy complications for the baby.

Yet antibiotic use should probably be restricted to cases where there is a clear benefit, rather than just in case, as this approach may contribute to the development of antibiotic resistance and may be associated with potential harm.

If you’re concerned about your doctor  recommending antibiotics in pregnancy feel free to engage them in a conversation about whether this is necessary. You will both be happier with the decision if you’ve been able to have your questions answered.

While this study has suggested an association between antibiotics in pregnancy and health of children, it does not prove a causative link. More research is needed to clarify this further.

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