title: Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.
abstract: BACKGROUND
  Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants.
  
  
  OBJECTIVE
  Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality.
  
  
  METHODS
  We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications.
  
  
  RESULTS
  Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics.
  
  
  CONCLUSIONS
  There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.
authors: Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi. gkafulafula@jhu.medcol.mw
authors: George
authors: G
authors: Kafulafula
authors: Anthony
authors: A
authors: Mwatha
authors: Ying Qing
authors: YQ
authors: Chen
authors: Said
authors: S
authors: Aboud
authors: Francis
authors: F
authors: Martinson
authors: Irving
authors: I
authors: Hoffman
authors: Wafaie
authors: W
authors: Fawzi
authors: Jennifer S
authors: JS
authors: Read
authors: Megan
authors: M
authors: Valentine
authors: Kasonde
authors: K
authors: Mwinga
authors: Robert
authors: R
authors: Goldenberg
authors: Taha E
authors: TE
authors: Taha
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002821:Chorioamnionitis / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D047928:Premature Birth; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents