Antibiotics During Pregnancy – Is It Safe?

Why I Need Antibiotics During Pregnancy?

If you encounter any infection in your body due to bacteria your doctor may put you on antibiotics.Infections in pregnancy if left untreated may pass to the baby in the womb threatening both mother and fetus. Also untreated infections may spread to other body parts and reach the bloodstream at times which leads to major complications.

Another reason that you receive Antibiotics is when your water breaks prematurely which increases the chances of infection in the womb. Antibiotics are a must in these scenarios to safeguard you and your baby.

You may need antibiotics when the doctor finds you have a risk of streptococcus infection at the end of the term before your delivery. Again it is to protect you and baby from potential risks like meningitis, sepsis and pneumonia etc. (2)

Is It Safe To Take Antibiotics During Pregnancy?

So you have an infection that may need treatment. And the doctor prescribes a course of antibiotics. The immediate question that will strike your mind is how safe is the use of antibiotics during pregnancy time?

Well, it depends. Some of the antibiotics are quite safe and can be easily taken during pregnancy time. At the same time, some are lethal for the baby, and many medicines are intermediate between the two extreme sides. The last category of antibiotics is not safe for use in pregnancy, as it can cause potential risk to the mother as well as the newborn baby too.

Antibiotics In The First Trimester

The first trimester is a crucial one – on one side, the pregnancy hormones are running high, and on the other hand, the baby is experiencing rapid development in the form of organs. It is for this reason that pregnant women have advised the most care during the first trimester, and it comes as no surprise that antibiotics would be prescribed only if very, very necessary cases only.

Sometimes when you fall ill, there is no escape from taking antibiotics in spite of their known potential risks. It is because leaving the disease untreated is more dangerous for the mother and the baby than the threats posed to the baby by using antibiotics. Another important thing is that the safety of a medicine is also dependent upon other important factors such as the duration of its intake, its quantity or dosage and which trimester of pregnancy you are in at present also considered.

Antibiotics in the Second Trimester

Often doctors prescribe antibiotics like (macrolides or clindamycin) during the second trimester of pregnancy. Pregnant women at risk of preterm births can lower it. But recent research also says that giving metronidazole alone in the second trimester is linked with a higher risk of preterm birth.

Antibiotics in the Third Trimester 

Antibiotics in the third trimester are given as mandatory preventive care to reduce infections of vagina and GI tract after delivery. To prevent infections from rupture of the womb and vagina during delivery. It’s almost a routine to give a dose of antibiotics in term and preterm pregnancies to avoid infections to mother and fetus (3).

Classification Of Antibiotics Based on Safety

Nowadays, a variety of antibiotics are available on the market. However, some commonly used ones are cephalosporins (cephalexin), erythromycin, and penicillins (ampicillin, amoxicillin, etc.). The below classification will help us understand the effects of antibiotics on the pregnancy period:

• Category A: These are known to cause either nil or remote harm to the mother and the baby and are safe in pregnancy
• Category B: No known studies on pregnant women, but may have been found to have some adverse effects on animals. Most safe antibiotics are placed under this shelf
• Category C: Drugs under this category can be given to a pregnant woman only if the benefits outweigh the risks
• Category D: Given under extreme, threatening conditions positive evidence of risk on the human fetus
• Category X: Not to be administered to pregnant women in any case, these drugs have been associated with fetal abnormalities

Most Common Infections During Pregnancy

Here are the two common conditions faced during pregnancy, requiring the usage of antibiotics.

Vaginal Infections in Pregnancy and Antibiotics

Earlier metronidazole (a drug used for curing vaginal infections such as bacterial vaginosis and trichomoniasis) was considered to cause birth issues. But recent research has disapproved of the wrong notion. So, metronidazole is regarded as a safe drug and is used for treating vaginal infections in pregnancy time.

Pregnancy UTI Antibiotics

Urinary tract infection is quite a common condition encountered in pregnant women. Your doctor prescribes nitrofurantoin (Macrobid). The drug can be taken as long as the pregnancy has not reached 36 weeks. When your 36th week has started to avoid taking antibiotics as it can adversely affect the baby’s red blood cells.

Trimethoprim (trade name Bactrim and Septa) is also used to cure urinary tract infections, but its use in pregnancy is contraindicated. It interferes with folic acid absorption and can cause neural tube defects in the newborn baby.

Antibiotics That Should Be Strictly Avoided During Pregnancy

Antibiotics that should be strictly avoided during pregnancy time altogether are:

• Streptomycin is used in treating tuberculosis. If used in pregnancy, it can lead to hearing loss in the newborn baby.
• Tetracycline, minocycline, doxycycline, or oxytetracycline are used for curing acne, and respiratory ailments. But if used in pregnancy, can cause discoloration of the baby’s teeth.

The below antibiotics are also classified under ‘unsafe antibiotics for pregnant women during pregnancy:

• Ciprofloxacin
• Bactrim
• Doxycycline
• Furadantin
• Macrobid
• Macrodantin
• Minocycline
• Tetracycline

Precautions When Taking Antibiotics During Pregnancy

Here are some useful safety tips for ensuring the health of the mother as well as the baby at pregnancy:

• Never make the folly of treating a viral infection with antibiotics for two reasons. First, the antibiotics will not cure the infection, and second, their use will render you antibiotic-resistant so when you need antibiotics, they won’t be effective
• Eat a balanced and healthy diet
• Eat a lot of fresh fruits and vegetables. Citrus fruits are rich in vitamin C-the immunity enhancing vitamin
• Maintain good personal hygiene to keep infections at bay
• Avoid using other towels or toilets. This prevents the transmission of many infections from it

Birth Defects Caused By Antibiotics During Pregnancy

Antibiotics can cause life-threatening severe birth issues in babies. Those defeats are mentioned below:

• Anencephaly (a lethal malformation of the brain and skull)
• Transverse limb deficiency
• Choanal atresia (nasal passage blockage)
• Eye defects
• Diaphragmatic hernia
• Cleft palate
• Congenital heart defects

Safe Antibiotics For Pregnancy

Below is a list of antibiotics that are considered safe and can be used in pregnancy, if the need arises for pregnant women:

• Amoxicillin
• Ampicillin
• Penicillin
• Cephalexin
• Clindamycin
• Erythromycin
• Nitrofurantoin

Side Effects Of Antibiotics During Pregnancy

Antibiotics can have side effects as any other medicines we take. There are some common side effects that you may experience which are mild and can fade away once you stop using them. The common side effects include (4)-

• Diarrhea
• Constipation
• Nausea and vomiting
• Dizziness
• Yeast infections
• Mild rashes
• Loss of Appetite

Some of the most serious side effects include-

• Severe Allergic reactions like hives, shortness of breath etc can be life-threatening mostly in case of
• Penicillin antibiotics like Amoxicillin and Ampicillin
• Antibiotic-Resistant infections from misuse of Antibiotics
• Specific antibiotics like Nitrofurantoin may cause lung issues in rare cases
• Macrolide antibiotics like Azithromycin may lead to irregular heartbeat on prolonged use
• Cephalosporins like cephalexin can lead to seizures in a few cases on prolonged use.

The most common concern of using Antibiotics is that it may cause gut bacteria imbalance where good gut bacteria and good vaginal bacteria are also eradicated along with harmful bacteria. A healthy gut and Vaginal bacteria are very important for a healthy Pregnancy (5). 

Do not overuse any Antibiotics during pregnancy unless prescribed and get suggestions from your caretaker on how to improve good gut bacteria again after the course is finished.

FAQ’s

1. Which Antibiotics Can Cause Miscarriage?

The use of certain antibiotics during the early stages of pregnancy was associated with a greater likelihood of spontaneous abortion before 20 weeks. Antibiotics such as quinolones, tetracyclines, sulfonamides, metronidazole, and macrolides were included in this category (except erythromycin).

2. Can Antibiotics Cause Preeclampsia?

The risk of pre-eclampsia was found higher among pregnant women who needed a prescription for antibiotics. Preeclampsia rates are much higher in women who take methamphetamine during pregnancy.

3. Do Antibiotics Pass Through The Placenta?

Medicines having molecular weights below 500 g/mol may easily pass the placenta and reach the developing baby. Medicines having molecular weights over 500 g/mol have a more difficult time crossing the placenta, while medications with molecular weights above 1000 g/mol are unable to pass the placental barrier at all. Many commonly use.

Reference

1. Antibiotics – [https://www.ncbi.nlm.nih.gov/books/NBK535443/]
2. Group B Strep and Pregnancy – [https://www.acog.org/womens-health/faqs/group-b-strep-and-pregnancy]
3. Antibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154219/]
4. Antibiotic Use Questions and Answers – [https://www.cdc.gov/antibiotic-use/q-a.html]
5. Antibiotic use during pregnancy: how bad is it? – [https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0636-0]