2014 Feb 10;3(1):39-48. doi: 10.3390/antibiotics3010039. In 2011, the American College of Obstetricians and Gynecologists (ACOG) issued a Committee Opinion stating that sulfonamides and nitrofurantoin can be prescribed in the first trimester of pregnancy if other antimicrobial therapies are deemed inappropriate (American College of Obstetricians and Gynecologists Committee on Obstetric Practice, 2011). HHS Vulnerability Disclosure, Help The majority (68.2% of case, 66.6% of control mothers) also reported taking an antibiotic (Fig. The National Birth Defects Prevention Study by Crider and colleagues was a large, well-funded, and well-designed epidemiologic study. According to 2011 guidelines from the Infectious Diseases Society of America, nonpregnant women with uncomplicated UTIs should be treated with nitrofurantoin or trimethoprim-sulfamethoxazole. For pregnant women in their first trimester, a 2011 Committee Opinion from the American College of Obstetricians and Gynecologists recommended that sulfonamides and nitrofurantoin may be prescribed only if other antimicrobial therapies are deemed clinically inappropriate (4). Nevertheless, the study had certain limitations.4 The findings are subject to recall bias because the investigators questioned patients about antibiotic use after, rather than during, pregnancy. CDC twenty four seven. To exercise an abundance of caution, I recommend that nitrofurantoin not be used in the first trimester of pregnancy unless no other antibiotic is likely to be effective. FOIA Most babies will not have this problem, but your doctor may recommend a different antibiotic if you are in the third trimester of pregnancy. mmwrq@cdc.gov. Supported by an appointment to the Research Participation Program at the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC. Ailes EC, Summers AD, Tran EL, et al. Am Fam Physician 2000;61:71321. Overall, 68.9% of women with an outpatient UTI filled a prescription for an antibiotic within 7 days of their outpatient visit during pregnancy (median = 0 days, standard deviation = 1.1 days). 1). Arch Pediatr Adolesc Med 2009;163:97885. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Information was obtained on maternal demographics; nutritional, behavioral, and occupational exposures; maternal disease including infections; and over-the-counter and prescription medications, vitamins, and supplements. But some studies reported higher rates of birth defects when it was taken in the . To control for potential confounding by indication, we examined associations between antibiotic use and birth defects, among women reporting urinary tract infections (UTIs). Using insurance claims data to identify and estimate critical periods in pregnancy: an application to antidepressants. Clinical data regarding the birth defects were abstracted from medical records, and birth defects were classified by clinicians and clinical geneticists using previously described NBDPS classification criteria (Rasmussen et al., 2003; Botto et al., 2007). Write a review. Obstet Gynecol. Furthermore, the birth defects found to be associated with antibiotics in this study (cleft lip with or without cleft palate, esophageal atresia, diaphragmatic hernia, and anorectal atresia/stenosis) are rare, with a birth prevalence of approximately 0.99%, 0.22%, 0.27%, and 0.41%, respectively, reported by active birth defects surveillance programs during the period 2008 to 2012 (Mai et al., 2015). Recall of medication timing is often better for short-term use, the circumstance for most of our antibiotic exposures, and is also improved when women are prompted with specific medication names, a feature of our study as well (Mitchell et al., 1986; Radin et al., 2013). Bethesda, MD 20894, Web Policies While medical literature generally defines nitrofurantoin as an antibiotic that is safe for use during the first tri. Ann Epidemiol 2003;13:47983. 2). 2009 Jun 11;360(24):2528-35. doi: 10.1056/NEJMoa0807154. Nitrofurantoin and trimethoprim-sulfamethoxazole are commonly prescribed and dispensed to women with urinary tract infections during their first trimester of pregnancy. Later in the questionnaire, women were asked if they took any medications not already discussed and to provide the name, dates taken, duration, and frequency of use, although not the specific indication for use. Kobayashi M, Shapiro DJ, Hersh AL, Sanchez GV, Hicks LA. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Acute porphyria. Obstet Gynecol. Few published studies describe the associations between cephalosporins and birth defects. If an antibiotic is the best way to treat your condition, your doctor will prescribe the safest antibiotic and dosage. Second, given the large number (n = 43) of associations examined, multiple comparisons might have impacted our results because approximately two statistically significant associations would be expected by chance alone; however, we do not know which of the four associations we observed are more likely to be due to chance alone. Saving You Time. Despite this recommendation, a recent large commercial database study indicated that 43% of women were prescribed nitrofurantoin or trimethoprim-sulfamethoxazole in their first trimester. The dominant organisms that cause lower UTIs in pregnant women are Escherichia coli, Klebsiella pneumoniae, Proteus species, group B streptococci, enterococci, and Staphylococcus saprophyticus. MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. 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. Cleves MA, Malik S, Yang S, et al. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. This approach has been used in other studies (Berkovitch et al., 2000; Hansen et al., 2016). While medical literature generally defines nitrofurantoin as an antibiotic that is safe for use during the first trimester of pregnancy, new concerns about a possible association between congenital malformations following exposure to nitrofurantoin during the first trimester of pregnancy have recently surfaced. Understandably, the investigators were not able to verify the prescriptions for antibiotics by reviewing each individual medical record. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. official website and that any information you provide is encrypted Core elements of outpatient antibiotic stewardship. 8600 Rockville Pike Comfort in selecting this antibiotic comes from its friendly FDA pregnancy category B rating and long history of safe and effective use. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Nordeng H, Lupattelli A, Romoren M, Koren G. Neonatal outcomes after gestational exposure to nitrofurantoin. This drug also should be avoided just prior to expected delivery because it can displace bilirubin from protein-binding sites in the newborn and increase the risk of neonatal jaundice. The authors did not precisely distinguish between single-agent sulfonamides and the combination drug, trimethoprim-sulfamethoxazole, although it seems reasonable to assume that the majority of the prescriptions were for the latter. 8600 Rockville Pike See more with MDedge! DOI: http://dx.doi.org/10.15585/mmwr.mm6701a4external icon. Exposure to nitrofurantoin during early pregnancy and congenital malformations: a systematic review and meta-analysis. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Delzell JE Jr, Lefevre ML. In a review of eight studies, a link between nitrofurantoin and birth defects wasn't seen in most studies. Dihydrofolate reductase inhibitor use in early pregnancy has also been associated with a variety of reproductive outcomes, including miscarriage and selected birth defects (Andersen et al., 2013a, 2013b; Hernandez-Diaz et al., 2000, 2001). Copyright 2023Frontline Medical Communications Inc., Newark, NJ, USA. The authors concluded that 43% of women used an antibiotic (nitrofurantoin or trimethoprim-sulfamethoxazole) in the first trimester that had potential teratogenicity, despite the precautionary statement articulated in the ACOG committee opinion.2, Related Results from the posthoc analyses were similar to those of the primary analysis. Nitrofurantoin and trimethoprim-sulfamethoxazole are commonly prescribed and dispensed to women with urinary tract infections during their first trimester of pregnancy. Seeking causes: classifying and evaluating congenital heart defects in etiologic studies. Pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications. Nitrofurantoin passes into breast milk in small amounts and is unlikely to cause side effects in your baby. The studies were assessed without knowing the results. The first prescription filled was used to capture the initial treatment for the UTI. For cephalosporins, there were nine calculable odds ratio; nonsignificantly elevated odds ratios were observed for pulmonary valve stenosis, perimembranous ventricular septal defects, neural tube defects overall, and the subtype of spina bifida, and oral clefts overall, as well as the subtype of cleft lip with or without cleft palate. Antibiotic information was more problematic; close to one-quarter of women could not recall the name of the antibiotic taken. Do not take nitrofurantoin while breastfeeding if your baby has: If your baby is not feeding as well as usual, has a stomach upset, or has oral thrush (a fungal infection in their mouth), or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife. All subjects consented to participation and the NBDPS was approved by the Institutional Review Boards at the Centers for Disease Control and Prevention and all participating institutions. Nordeng H, Lupattelli A, Romoren M, Koren G. Neonatal outcomes after gestational exposure to nitrofurantoin. sharing sensitive information, make sure youre on a federal Urinary tract infections during pregnancy. the contents by NLM or the National Institutes of Health. Delzell JE, Jr, Lefevre ML. The https:// ensures that you are connecting to the Subsequent studies of nitrofurantoin use in pregnancy have not found it to be associated with birth defects, although these studies may have been underpowered to detect associations with specific birth defect types (Goldberg et al., 2013; Nordeng et al., 2013). Thus, misclassification could have occurred with respect to the length of gestation, type of infection, the occurrence or timing of UTIs, and dispensing of antibiotics. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 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. the date of publication. Outpatient antibiotic prescribing practices for uncomplicated urinary tract infection in women in the United States, 20022011. 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