Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study.
OBJECTIVE
To estimate the association between antibacterial medications and selected birth defects.


METHODS
Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941).


METHODS
Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester).


METHODS
Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders.


RESULTS
The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect).


CONCLUSIONS
Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.
Crider
Krista S
KS
Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. kcrider@cdc.gov
Cleves
Mario A
MA
Reefhuis
Jennita
J
Berry
Robert J
RJ
Hobbs
Charlotte A
CA
Hu
Dale J
DJ
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000757:Anencephaly / Q000139:chemically induced / Q000453:epidemiology; D000853:Anophthalmos / Q000139:chemically induced / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects; D002754:Choanal Atresia / Q000139:chemically induced / Q000453:epidemiology; D002971:Cleft Lip / Q000139:chemically induced / Q000453:epidemiology; D002972:Cleft Palate / Q000139:chemically induced / Q000453:epidemiology; D004917:Erythromycin / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000139:chemically induced / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D017880:Limb Deformities, Congenital / Q000139:chemically induced / Q000453:epidemiology; D008850:Microphthalmos / Q000139:chemically induced / Q000453:epidemiology; D008875:Middle Aged; D009582:Nitrofurantoin / Q000009:adverse effects; D010406:Penicillins / Q000009:adverse effects; D011159:Population Surveillance; D011247:Pregnancy; D015363:Quinolones / Q000009:adverse effects; D013449:Sulfonamides / Q000009:adverse effects; D013754:Tetracyclines / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D015363:Quinolones; D013449:Sulfonamides; D013754:Tetracyclines; D004917:Erythromycin; D009582:Nitrofurantoin