First-Trimester Antibiotic Use for Urinary Tract Infection and Risk of Congenital Malformations
Abstract
IMPORTANCE: Clinical guidelines recommend screening and treating bacteriuria in early pregnancy given that urinary tract infections (UTIs) can cause serious maternal and neonatal consequences. Evidence regarding antibiotic exposure during early pregnancy and risk of congenital malformations is limited and inconsistent.
OBJECTIVE: To compare the risk of congenital malformations following first-trimester exposure to different antibiotic agents used to treat UTI.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included commercially insured pregnant individuals aged 15 to 49 years who were treated for UTI and linked liveborn infants in the Merative MarketScan Commercial Database (2006-2022).
EXPOSURE: First-trimester antibiotic prescription fill of nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin), and β-lactams to treat UTI.
MAIN OUTCOMES AND MEASURES: Congenital malformations (any and by organ system) were identified using validated algorithms based on diagnosis codes up to 365 days after birth. Log-binomial regression models were used to estimate propensity score-weighted risk ratios (RRs) and risk differences.
RESULTS: The cohort of 71 604 eligible pregnancies (median maternal [IQR] age, 30 [27-34] years) included 42 402 (59.2%) nitrofurantoin-exposed, 3494 (4.9%) TMP-SMX-exposed, 3663 (5.1%) fluoroquinolone-exposed, and 22 045 (30.8%) β-lactam-exposed individuals. Median (IQR) gestational…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,000 participants or records.
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