Birth Defects Linked to Antibiotic Usage

Here’s the  link to the article. First, it’s important to note that there are some weaknesses to the study, in that it relied on the mothers’ recollection 6 weeks to 2 years after the birth which may cause problems in two ways: first, that some women may have misremembered (e.g., they may have thought the drug they were given for their bladder infection was an antibiotic, when it wasn’t; or they actually did take an antibiotic when they thought it was something else), and secondly, about a third of the women couldn’t remember what the antibiotic was that they had taken. [Why didn’t they check their records? It should be in both the prescribing physician’s file as well as in the pharmacy’s computers. Seems a simple and easy thing to do, but I digress…] Secondly, it’s important to note that it’s possible that the increase in birth defects was not due to the drug, but to some underlying condition (perhaps the bladder infection itself, or something else which made the woman more likely to get a bladder infection in the first place — who knows?). Thirdly, since the risk is rare, this is not a call to let a sick woman get sicker and sicker and sicker. After all, if she dies or has a miscarriage from a massive, untreated infection, that’s not very good for the baby, either!

Birth defects linked to sulfa drugs included rare brain and heart problems, and shortened limbs. Those linked to nitrofurantoins included heart problems and cleft palate. The drugs seemed to double or triple the risk, depending on the defect.”These defects are rare. Even with a threefold increase in risk, the risk for the individual is still quite low,” Crider said.

The good news is that penicillins seem to be the safest, and they are the most commonly prescribed drugs. Penicillins include Amoxil (amoxicillin); sulfa drugs include Bactrim (sulfamethoxazole and trimethoprim, if I’m remembering correctly); nitrofurantoins include Macrobid.

It’s important to remember that antibiotics don’t work with viruses, so taking these drugs does not actually help if you’ve got a viral infection; and then you’re just exposed to the risk (however minimal) without any corresponding benefit. These drugs actually predate the FDA, and their safety has been more assumed than proven. [If there were massive risks, this would have been discovered by now, because probably billions of people have taken these medicines since the 1930s, so the assumption is a pretty safe bet.] Yet, pregnancy is a tricky situation — with embryonic development being so sensitive a part of the development of the child, nobody wants another Thalidomide type of event! But it’s not exactly ethical to give pregnant women drugs just to see what happens to their babies, like the Nazis did. So there is a fine line.

When I worked at the pharmacy, I witnessed first-hand the great and royal run-around from doctors who were all unwilling to be the one to say, “Yes, this is fine to take during pregnancy.” I remember one “pass the buck” incident, in which a pregnant woman went to her GP for a cold or something, and he told her that her OB would have to prescribe something for her since she was pregnant. We called the OB, and he said that he didn’t know what to prescribe for a cold — he was an obstetrician, after all, and wanted the pharmacist to recommend something. The pharmacist didn’t want to be the one to “prescribe” something, because that was out of his purview. Undoubtedly, part of the reason for everyone’s hesitance was not wanting to be sued for prescribing something, even if it was done with the best of intentions, and the best knowledge available at the time.

8 Responses

  1. You should do a post on the useage of Theriflu (sp?) during pregnancy since A LOT of pregnant woman are seemingly thrown the drug if they feel a little off and someone they know has the flu….sounds a bit dangerous and over reaching to me!

    • Theraflu is an OTC cold preparation I think made by Tylenol (perhaps taken off the market now, since it contained some ingredient for meth?). I think you’re meaning Tamiflu. Good suggestion, and I may look into it. I know that there were some concerns raised in Japan a few years ago, with teenagers who became suicidal after taking it. So, yeah, it could be bad. I don’t know if there have been any similar things lately, or if those fears were later proven to be unfounded. One article I briefly glanced at said that 50 million people had taken Tamiflu, so it’s still a low incidence. It was high enough that Japan banned teens from taking Tamiflu, though!

      You have to weigh the risks and benefits of both taking and not taking it. On another blog, one commenter said that she was aware of the death of a pregnant woman (perhaps her baby, too, I can’t remember if the baby lived or not). Her doctor refused to prescribe her Tamiflu because she was pregnant, although the rest of the family got it, and she died of the flu. Tough call, if Tamiflu raises some risks, but lowers other risks. I’ll need to do some more research…

      • Yes, the woman died but the baby lived. It was in the news in our area. I also have a friend who will not give her son Tamiflu again because he had hallucinations. So there are risks and benefits all around.

  2. I would imagine timing is everything, however. For instance, I just had a penicillin-resistant UTI that was threatening to turn into a kidney infection, and was prescribed Bactrim by my perinatologist. I was worried at first, because I know that it is an agonist to folate and thus is linked to spinal/brain and heart defects. But I looked it up in an embryology text, and at the time of the prescription I was 8 weeks pregnant, and even at that stage of gestation the heart is already fully formed and the neural tube is closed. You’d have to take the drugs sometime after implantation but before 6.5 weeks LMP to end up with those severe birth defects. A pretty narrow window, and they really should explain that better.

    • True. They also don’t say what the very low risk is, and for a numbers person like me, that is what I really like to know. For instance, if the 3x higher incidence makes it go from 1/1000 to 3/1000, that’s a much bigger jump than 1/100,000 or 1/1,000,000!

      Also, your comment about folate sparks another question, or avenue of interest — could the negative effects of Bactrim be counter-balanced by taking extra folic acid? I’d have to look up to see if there are any negative effects of taking more than the minimum suggested amounts of folic acid (for either mother or baby), but if there are no risks with moderate-to-high doses and potential benefit, then perhaps doctors should suggest/prescribe that when women present with infections requiring antibiotics such as Bactrim.

  3. I meant the Tamiflu thing……Some peple will need it but it is yhe over perscription that bothers me… Not balancing it out properly.

    • I’ve kept this in my mind, but haven’t had the time to do the research; then something from the BMJ — several articles on Tamiflu — landed in my lap, essentially saying that the data may not be as strong as we were led to believe. You may need to register to read the articles (but if you do, it’s free), but here is the original link with many “rapid responses” and links to other BMJ Tamiflu articles. Interesting stuff.

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