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Are Antibiotics Safe to Use During Pregnancy?

<blockquote> <h3>Fast Facts:</h3> <ul> <li>According to the Centers for Disease Control (CDC), around 1 in 4 pregnant women are prescribed at least one course of antibiotics during pregnancy, which accounts for nearly 80% of prescriptions for pregnant women.</li> <li>Based on the Pregnancy and Lactation Labeling Rule (PLLR), all prescription medications, including antibiotics, but excluding over-the-counter medications, are required to have a label containing detailed information regarding a person’s pregnancy-, lactation-, and reproductive-risk related to the drug.</li> <li>Penicillin, such as Amoxicillin, is commonly used for a variety of bacterial infections. They are often the first-choice antibiotics during pregnancy because they are classified as safe to use and have not been shown to cause any birth defects.</li> <li>Some antibiotics have been linked to pregnancy loss and birth defects and should be avoided, if possible, especially during the first 20 weeks of pregnancy.</li> </ul> </blockquote> If you’re pregnant or are thinking about getting pregnant, you probably already know the basic pregnancy “dos and don’ts”: do take your prenatal vitamins, don’t smoke, do drink plenty of water, don’t drink alcohol, do eat healthy foods, don’t eat sushi, do get plenty of rest, don’t change the kitty litter, and so on and so forth. Admittedly, some of these sound like old wives’ tales such as, “don’t eat spicy foods because it can burn your unborn baby’s eyes.” But for the most part, you should be following these recommendations if you’re pregnant because there’s scientific evidence that most of these activities can impact the health of your growing baby. But what about antibiotics? Do you or don’t you take antibiotics while pregnant? Read on to find out if it is safe to take antibiotics during pregnancy. <h2>Antibiotics: a lifesaving marvel</h2> Antibiotics are a marvel of modern medicine and have saved millions of lives. They are a class of drugs that are used to fend off infections caused by harmful bacteria. Antibiotics do this either by killing the bacteria or by destroying the machinery that helps bacteria replicate or reproduce inside you. Our world is full of bacteria. Some are good for you (think: your gut or skin microbiome) and others don’t affect you at all. But then, there are those that cause infections, which can lead to serious illness – the ones that might need a course of antibiotics to get rid of. Unfortunately, bacterial infections can happen anytime, even when you’re pregnant. In fact, you may even be more prone to them when you’re pregnant because your immune system is weakened during certain periods of your pregnancy. Because your baby is growing inside you, your baby is more vulnerable to infections, too. <h2>But is it safe to take antibiotics while pregnant?</h2> The short answer is, yes, antibiotics are safe to take during pregnancy – but it depends on the type of antibiotic. There are certain antibiotics that are not prescribed to pregnant women due to the potential risks of birth defects. But for the most part, antibiotics are safe for both you and your growing baby. According to the Centers for Disease Control (CDC), needing to take an antibiotic during pregnancy is quite common. Around 1 in 4 pregnant women are prescribed at least one course of antibiotics during pregnancy, which accounts for nearly 80% of prescriptions for pregnant women. <h2>What infections do you need to take antibiotics for when pregnant?</h2> If you happen to find yourself with a bacterial infection during pregnancy, take the antibiotic that has been prescribed to you by a medical doctor. The benefits of taking the antibiotic, and treating the infection, often outweigh the potential risks of not taking it. Not treating a bacterial infection while pregnant can, in certain cases, become life-threatening. <h3>Common conditions during pregnancy that might need antibiotics</h3> Some common conditions that you might take antibiotics for during pregnancy include: <ul> <li>Urinary tract infections (UTIs), which are infections that occur in any part of your urinary tract, including your bladder, urethra, and kidneys. UTIs are the most common bacterial infection during pregnancy with at least 5% of pregnant women having it at least once during pregnancy, and of those women, 1 in 3 of them have it more than once. The reason UTIs are so common is because as your growing baby gets heavier, it can put pressure on your bladder and urinary tract, which can interfere with proper drainage. If your bladder cannot fully drain, an infection can grow. If left untreated, the UTI could lead to a serious kidney infection, which has been linked to preterm labor. <img alt="Pregnancy and Urinary Tract Infections" src="https://cdn.storymd.com/optimized/1dmYRJiLdp/thumbnail.jpg" /> Pregnancy and Urinary Tract Infections. Source: TheVisualMD/CDC </li> </ul> <ul> <li>Group B Streptococcus (GBS) is a bacterium that can cause an infection in some people. In the United States, about 1 in 4 pregnant women carry GBS in their body, but because it typically causes no symptoms, many women don’t even know they have been infected. For some women, however, infection with GBS can cause serious illnesses such as pneumonia, meningitis, sepsis, seizures, and even cause death to their newborn baby if passed to them during childbirth. For this reason, the CDC updated their guidelines to include GBS screening in week 36 to 37 of pregnancy to avoid it being inadvertently passed onto your newborn. If it turns out you’re GBS-positive, you will be given an intravenous (IV) antibiotic during labor to kill the bacteria and prevent it from infecting your baby. </li> </ul> <ul> <li>Bacterial vaginosis (BV) is caused by an overgrowth of harmful bacteria in your vagina. If you develop BV, you may notice a light or heavy discharge that has a slight “fishy” smell. If BV is left untreated, it can infect your uterus and fallopian tubes and it has been associated with premature birth, premature rupture of the fetal membranes, and an infection of the amniotic fluid – all of which can harm your baby. And so, it is extremely important to treat BV with certain antibiotics that can either be taken orally or inserted as a cream into the vagina.</li> <li>Listeria infection (listeriosis) is a type of bacterial infection that comes from eating contaminated foods that contain listeria bacteria. You are 10 times more likely to get a listeria infection when you are pregnant, and it can cause pregnancy loss, stillbirths, and preterm labor. However, a course of antibiotics typically does the trick to kill the bacteria. <img alt="Listeria Infection in Pregnant Women" src="https://cdn.storymd.com/optimized/RA8rrVU9d9/thumbnail.jpg" /> Listeria Infection in Pregnant Women. Source: CDC</li> <li>Sexually transmitted diseases (STDs). Many STDs are “silent”, meaning they have no symptoms, but can cause serious health complications for both you and your baby. The good news is that some STDs like chlamydia, gonorrhea, and syphilis can be treated and cured with antibiotics that are safe to take during pregnancy. </li> </ul> There are other types of infections that can strike during pregnancy, but you get the picture – if you get a bacterial infection during pregnancy and your doctor prescribes you an antibiotic, take the antibiotic as directed. <h2>Which antibiotics are safe to take while pregnant?</h2> The good news is that many commonly used antibiotics are considered safe for use during pregnancy. However, there are certain antibiotics that are considered “unsafe” because they can potentially cause birth defects. To help doctors prescribe medications to pregnant women, there is the “Pregnancy and Lactation Labeling Rule (PLLR)”, which applies to prescription medications, including antibiotics, but excludes over-the-counter drug products (e.g., cold medications, cough syrup, etc.). The goal of the PLLR is to ensure that more detailed information is provided to doctors and other health care providers regarding potential pregnancy, lactation, or reproductive risks of the medication and to help make it easier for doctors to determine which drugs are safe and effective to use during pregnancy. The PLLR requires that all prescription medications contain a label with the following pregnancy-, lactation-, and reproductive-risk information: Pregnancy (includes Labor and Delivery): <ul> <li>Pregnancy Exposure Registry</li> <li>Risk Summary</li> <li>Clinical Considerations</li> <li>Data</li> </ul> Lactation (includes Nursing Mothers): <ul> <li>Risk Summary</li> <li>Clinical Considerations</li> <li>Data</li> </ul> Females and Males of Reproductive Potential: <ul> <li>Pregnancy Testing</li> <li>Contraception</li> <li>Infertility</li> </ul> Basically, the PLLR ensures that more information is provided on whether the drug crosses the placental barrier, how the drug might affect pregnant women and the baby, if the drug gets into breast milk, and whether the drug has any potential to cause infertility. You and your obstetrician can then make informed decisions about which drugs, including antibiotics, are safe to use. Based on the PLLR, the following list of antibiotic classes have been determined to be safe to use during pregnancy: <ul> <li>Penicillin, such as Amoxicillin, which is used to treat a variety of bacterial infections. They are often the first-choice antibiotics during pregnancy.</li> <li>Ampicillin, a penicillin-based antibiotic, is used during labor for women who are GBS-positive.</li> <li>Vancomycin, used in labor for GBS in those women who have a penicillin allergy.</li> <li>Cephalosporins, such as cephalexin, are another group of first-choice antibiotics that work similarly to penicillin and are used to treat other common bacterial infections.</li> <li>Nitrofurantoin, such as Macrobid, is typically used to treat UTIs.</li> <li>Erythromycin, which is more commonly used for dental-related and skin infections.</li> <li>Clindamycin cream, metronidazole, and Metrogel, which are commonly used to treat BV.</li> </ul> <h2>Which antibiotic is not safe during pregnancy?</h2> There are reasons to be cautious when taking antibiotics during pregnancy. Research has linked some antibiotics to pregnancy loss and birth defects and they should be avoided, especially during the first 20 weeks of pregnancy. One study published in the British Journal of Clinical Pharmacology looked at the link between fetal exposure to antibiotics and the risk of major birth defects. The researchers followed nearly 140,000 mothers and assessed their use of antibiotics during the first trimester and then identified birth defects for their newborns throughout their first year of life. Researchers found that the following antibiotics used during pregnancy were linked to various defects. These antibiotics include, but are not limited to: <ul> <li>Tetracycline, that is linked to causing a baby’s teeth to turn yellow, as well as hearing loss.</li> <li>Doxycycline, which is used to treat acne, UTIs, intestinal and eye infections, and other types of bacterial infections, that has been linked to cardiac malformations.</li> <li>Quinolones, broad-spectrum antibiotics, that have been linked to preterm births and</li> <li>pregnancy loss.</li> <li>Macrolides, such as azithromycin – the antibiotic in the Z-Pak – that is typically used to treat sinus infections, have been linked to heart defects.</li> <li>Sulfonamides, such as Bactrim, that have been linked to heart complications, cleft lip, and jaundice.</li> </ul> One thing to consider is that studies on some of these “unsafe” antibiotics have mixed conclusions on whether they are, in fact, harmful because it can be hard to determine for certain what caused a birth defect. Even if an antibiotic has been linked to an elevated risk of birth defects, the chances are still very low. For example, the baseline risk of having a baby with hypoplastic left heart syndrome (HLHS) is about 1 in 4,200. Sulfonamides have been shown to be associated with a 3-fold increase in HLHS, making the likelihood about 1 in 1,400, according to the National Center on Birth Defects and Developmental disabilities. So, while there is an increased risk of HLHS associated with sulfonamide use in pregnancy, the risk of HLHS is still very small. <h2>The takeaway</h2> Being pregnant doesn’t mean you should avoid antibiotics – or other medications for that matter. If you have a bacterial infection, the bacteria itself typically poses a much greater risk to your baby than the antibiotics. There are some antibiotics that are safer than others and that should be considered if you need to treat an infection. Your doctor will prescribe the best antibiotic for your infection. <h2>More on Pregnancy and Antibiotics</h2><ul><li><a href="https://soulivity.storymd.com/journal/vj6ko8oizm-antibiotics" target="_blank">The Proper Use of Antibiotics for Common Infections</a></li><li><a href="https://soulivity.storymd.com/journal/7m7aaa2fpm-pregnancy-and-medicines" target="_blank">Tips for the Safe Use of Medicines During Pregnancy</a></li><li><a href="https://soulivity.storymd.com/journal/vj6koy31zm-congenital-anomalies" target="_blank">Birth Defects: Types, Causes, Prevention</a></li></ul>

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