title: Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011.
abstract: BACKGROUND
  Previous studies noted associations between birth defects and some antibiotics (e.g., nitrofurantoin, sulfonamides) but not others (e.g., penicillins). It is unclear if previous findings were due to antibiotic use, infections, or chance. To control for potential confounding by indication, we examined associations between antibiotic use and birth defects, among women reporting urinary tract infections (UTIs).
  
  
  METHODS
  The National Birth Defects Prevention Study is a multi-site, population-based case-control study. Case infants/fetuses have any of over 30 major birth defects and controls are live-born infants without major birth defects. We analyzed pregnancies from 1997 to 2011 to estimate the association between maternally reported periconceptional (month before conception through the third month of pregnancy) use of nitrofurantoin, trimethoprim-sulfamethoxazole, or cephalosporins and specific birth defects, among women with periconceptional UTIs. Women with periconceptional UTIs who reported penicillin use served as the comparator.
  
  
  RESULTS
  Periconceptional UTIs were reported by 7.8% (2029/26,068) of case and 6.7% (686/10,198) of control mothers. Most (68.2% of case, 66.6% of control mothers) also reported antibiotic use. Among 608 case and 231 control mothers reporting at least one periconceptional UTI and certain antibiotic use, compared with penicillin, nitrofurantoin use was associated with oral clefts in the offspring (adjusted odds ratio, 1.97 [95% confidence interval, 1.10-3.53]), trimethoprim-sulfamethoxazole use with esophageal atresia (5.31 [1.39-20.24]) and diaphragmatic hernia (5.09 [1.20-21.69]), and cephalosporin use with anorectal atresia/stenosis (5.01 [1.34-18.76]).
  
  
  CONCLUSIONS
  Periconceptional exposure to some antibiotics might increase the risk for certain birth defects. However, because individual birth defects are rare, absolute risks should drive treatment decisions.Birth Defects Research (Part A) 106:940-949, 2016.© 2016 Wiley Periodicals, Inc.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ailes
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Gilboa
authors.affiliation: Duchesnay Inc, Blainville, Quebec, Canada.
authors.forename: Simerpal K
authors.initials: SK
authors.lastname: Gill
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cheryl S
authors.initials: CS
authors.lastname: Broussard
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Krista S
authors.initials: KS
authors.lastname: Crider
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Berry
authors.affiliation: Marshfield Clinic, Marshfield, Wisconsin.
authors.forename: Tonia C
authors.initials: TC
authors.lastname: Carter
authors.affiliation: College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Hobbs
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.|Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Interrante
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000900:Anti-Bacterial Agents; D005260:Female; D006801:Humans; D009313:National Health Programs; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic; birth defects; cephalosporin; nitrofurantoin; penicillin; trimethoprim-sulfamethoxazole; urinary tract infection