Antibiotics in pregnancy: analysis of potential risks and determinants in a large German statutory sickness fund population.
OBJECTIVE
Antibiotics are frequently prescribed drugs in pregnancy. The purpose of the study was to analyse the use, the potential risks and the determinants of systemic antibiotic prescriptions during pregnancy.


METHODS
A large, nation-wide acting German statutory sickness fund provided prescription data and personal data of 41,293 pregnant women. For this study, all prescriptions of systemic antibiotics (ATC: J01) dispensed to each woman during a 21-month period were analysed. We used the FDA risk classification system and enrolled a literature search to identify potentially harmful antibiotics. To investigate the impact of geographical and socio-economic determinants in antibiotic prescribing, a multivariate logistic regression model was performed.


RESULTS
Of the 41,293 women, 19.7% received at least one antibiotic drug during pregnancy. There was a shift to relatively safe and reduced antibiotic drug use during pregnancy. Prescribing of contraindicated antibactericals or potentially harmful drugs was seen in 521 women (1.3% of all women). In the logistic regression, being younger than 21 years (adjusted OR 2.14, 95%CI 1.80-2.53) or being welfare recipient (adjusted OR 1.57, CI 1.25-2.00) was strongly associated with higher antibiotic use. Significantly lower antibiotic use was seen in 5 of 16 German federal states (OR 0.74-0.83).


CONCLUSIONS
About 20% of pregnant women received antibiotics, and 1.3% received a harmful drug. To minimise the risks, detailed guidelines are needed for the antibiotic treatment during pregnancy.
Amann
Ute
U
Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany. ute.amann@t-online.de
Egen-Lappe
Veronika
V
Strunz-Lehner
Christine
C
Hasford
Joerg
J
D000014:Abnormalities, Drug-Induced; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004363:Drug Utilization; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012306:Risk
D000900:Anti-Bacterial Agents