In utero exposure to antibiotics and risk of congenital malformations

a population-based study

Per Damkier*, Louise M.S. Brønniche, Johan F.B. Korch-Frandsen, Anne Broe

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics. Objective: To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark. Materials and Methods: This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income. Results: We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06–1.19; and odds ratio, 1.15; confidence interval, 1.04–1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07–1.24; and odds ratio, 1.22; confidence interval, 1.07–1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03–1.38; and odds ratio, 1.29, confidence interval, 0.99–1.67, respectively). Conclusion: In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
ISSN0002-9378
DOIs
Publication statusPublished - 2019

Fingerprint

Odds Ratio
Confidence Intervals
First Pregnancy Trimester
Population
Denmark
Amdinocillin Pivoxil
Pivampicillin
Cohort Studies
Penicillin V
Social Adjustment
Educational Status
Azithromycin
Maternal Age
Parity
Uncertainty
Registries
Pregnant Women
Body Mass Index
Logistic Models
Smoking

Keywords

  • antibiotics
  • congenital malformations
  • pregnancy

Cite this

@article{1b83e11bad6f49e48bed1e6278e8c2d4,
title = "In utero exposure to antibiotics and risk of congenital malformations: a population-based study",
abstract = "Background: Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics. Objective: To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark. Materials and Methods: This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income. Results: We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06–1.19; and odds ratio, 1.15; confidence interval, 1.04–1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07–1.24; and odds ratio, 1.22; confidence interval, 1.07–1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03–1.38; and odds ratio, 1.29, confidence interval, 0.99–1.67, respectively). Conclusion: In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.",
keywords = "antibiotics, congenital malformations, pregnancy",
author = "Per Damkier and Br{\o}nniche, {Louise M.S.} and Korch-Frandsen, {Johan F.B.} and Anne Broe",
year = "2019",
doi = "10.1016/j.ajog.2019.06.050",
language = "English",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby, Inc.",

}

In utero exposure to antibiotics and risk of congenital malformations : a population-based study. / Damkier, Per; Brønniche, Louise M.S.; Korch-Frandsen, Johan F.B.; Broe, Anne.

In: American Journal of Obstetrics and Gynecology, 2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - In utero exposure to antibiotics and risk of congenital malformations

T2 - a population-based study

AU - Damkier, Per

AU - Brønniche, Louise M.S.

AU - Korch-Frandsen, Johan F.B.

AU - Broe, Anne

PY - 2019

Y1 - 2019

N2 - Background: Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics. Objective: To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark. Materials and Methods: This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income. Results: We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06–1.19; and odds ratio, 1.15; confidence interval, 1.04–1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07–1.24; and odds ratio, 1.22; confidence interval, 1.07–1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03–1.38; and odds ratio, 1.29, confidence interval, 0.99–1.67, respectively). Conclusion: In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.

AB - Background: Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics. Objective: To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark. Materials and Methods: This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income. Results: We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06–1.19; and odds ratio, 1.15; confidence interval, 1.04–1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07–1.24; and odds ratio, 1.22; confidence interval, 1.07–1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03–1.38; and odds ratio, 1.29, confidence interval, 0.99–1.67, respectively). Conclusion: In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.

KW - antibiotics

KW - congenital malformations

KW - pregnancy

U2 - 10.1016/j.ajog.2019.06.050

DO - 10.1016/j.ajog.2019.06.050

M3 - Journal article

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

ER -