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Macrolide Antibiotic Use During Pregnancy Linked to Higher Risk of Cerebral Palsy and Epilepsy

Mar 31, 2015

New research suggests that the use of macrolide antibiotics during pregnancy could increase the risk of giving birth to a child with epilepsy or cerebral palsy. The study, which was conducted by researchers from the UCL Institute of Child Health (ICH) in London, was published in PLOS One on March 25th.

The study was led by Ruth Gilbert, professor of clinical epidemiology at ICH. He noted that an infection can be serious and that antibiotics are often necessary, but the risks of the drug should not be ignored. "If you have an infection, take the antibiotics," Gilbert says. "But on a population basis, we need to consider whether we should recommend alternatives."

"There is now a large body of evidence of adverse effects of macrolides in different populations, during pregnancy and in adults," says Gilbert. "There are three very large database studies in adults showing an association between macrolides and cardiac deaths and cardiac events. Very rare, low risk, but still there."

The study follows evidence of harm associated with prenatal antibiotics in a large trial of over 4,000 women in preterm labor taking prophylactic antibiotics. Researchers looked at data using a cohort of 195,909 women to study the risk of cerebral palsy and epilepsy with antibiotic use. The study followed children from birth to a median of 3.6 years.

"There's an accumulation of signals here that need to be looked at by a medicines regulator and by people who write the guidelines," Gilbert states.

Although the study did not find a link between any antibiotic use and cerebral palsy or epilepsy after accounting for confounding factors, findings did reveal a slightly higher risk with macrolides, such as erythromycin and clarithromycin, compared to penicillins. In children whose mothers were prescribed macrolides, the incidence of cerebral palsy or epilepsy was 254.6 per 100,000 child-years-at-risk compared with 143.6 in children whose mothers were prescribed penicillin.

"We found no overall association between antibiotic prescribing in pregnancy and cerebral palsy and/or epilepsy in childhood. However, our finding of an increased risk of cerebral palsy or epilepsy associated with macrolide prescribing in pregnancy adds to evidence that macrolide use is associated with serious harm." the authors concluded.

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