Abstract
Although pregnancy is considered as a physiological state, most pregnant women in developed countries receive multiple medications to prevent maternal or neonatal complications, with antibiotics among the most frequently prescribed. During pregnancy, antibiotics are often prescribed in the context of preterm labor, intrapartum fever, prevention of neonatal Group B Streptococcus fever, and cesarean section. Outside this period, they are commonly prescribed in the community setting for respiratory, urinary, and ear, nose and throat infection symptoms. Whereas some of the current indications have insightful reasons to justify their use, potential risks related to overuse and misuse may surpass the benefits. Of note, the recent 2014 World Health Assembly expressed serious concern regarding antibiotic resistance due to antibiotic overuse and misuse and urged immediate action to combat antibiotic resistance on a global scale. Most studies in the obstetrics field have focused on the benefits of antibiotics for short-term maternal and neonatal complications, but with very little (if any) interest in long-term consequences.
Highlights
Most pregnant women are exposed to some type of medication during pregnancy
We review here some of the most common indications for prescribing antibiotics during pregnancy and discuss the potential associated risks, including strategies aimed at reducing these risks
Maternal infection was reduced with the use of any prophylactic antibiotics compared with placebo (average risk ratio (RR): 0.74; 95% confidence interval (CI) = 0.63–0.86; number needed to treat to benefit (NNTB): 34; 95% CI = 24–63) and with any beta-lactam antibiotic compared with non-beta-lactams (RR: 0.80; 95% CI = 0.69–0.92; NNTB: 47; 95% CI = 31–119)
Summary
Most pregnant women are exposed to some type of medication during pregnancy. Drugs prescribed during pregnancy can exercise a teratogenic effect on fetuses, and those prescribed during breastfeeding can impact on infant health. If other antibiotic indications during pregnancy are taken into account, such as the screening and treatment of asymptomatic bacteriuria or bacterial vaginosis (BV), as well as the overuse of antibiotics to treat respiratory and genital infections, it is evident that the huge majority of fetuses today have been exposed to antibiotics before delivery. Whereas some of these therapeutic strategies have been shown to be beneficial to reduce short-term maternal and neonatal complications, their long-term effects are by far less well known. When prescribing antibiotics to a pregnant woman, we should ask ourselves: are they really indicated and are we doing more harm than good?
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