Does Antibiotic Use Increase Risk of Spontaneous Abortion?
This study by Muanda et al. (CMAJ, 2017) aimed to determine if antibiotic use during pregnancy is associated with spontaneous abortion.
Nested Case-Control Study
Each case of spontaneous abortion (<20 weeks’ gestation) was matched for gestational age and year against 10 randomly selected controls. Antibiotic use was compared to non-exposure and exposure to penicillins or cephalosporins. After adjusting for potential confounders, multiple types of antibiotic use were associated with an increased risk of spontaneous abortion: azithromycin (adjusted odds ratio 1.65, 95% CI 1.34-2.02) clarithromycin (adjusted odds ratio 2.35, 95% CI 1.90-2.91), metronidazole (adjusted odds ratio 1.70, 95% CI 1.27-2.26), sulfonamides (odds ratio 2.01, 95% CI 1.36-2.97), tetracyclines (adjusted odds ratio 2.59, 95% CI 1.97-3.41) and quinolones (adjusted odds 2.72, 95% CI 2.27-3.27). These findings held whether comparing against non-exposure or exposure to penicillins or cephalosporins. The authors note that one potential confounder, that of severity of infection, could not be assessed in this study. Nevertheless, they do suggest that macrolides (excluding erythromycin) quinolones, tetracyclines, sulfonamides and metronidazole may be associated with miscarriage prior to 20 weeks and policies may need to update guidelines to reflect these findings.
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