Macrolides During Pregnancy May Raise Cerebral Palsy, Epilepsy Risk

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Women who take macrolides during pregnancy may increase their child’s risk of developing cerebral palsy or epilepsy compared with those who take penicillin, according to a study published in PLoS ONE.

Previously, the ORACLE Childhood Study II found that antibiotic use by pregnant women with spontaneous preterm labor increased the child’s chance of developing cerebral palsy and possibly epilepsy. The researchers wanted to see if this outcome held true for infants delivered at term.

The study included data on 195,909 women and live, term-born children from The Health Improvement Network. The researchers looked at antibiotic class, number of courses, and time of prescribing during pregnancy. Each child was monitored until age 7 or until they stopped seeing their primary-care physician.

The analysis showed that 64,623 (33.0%) women had been prescribed antibiotics during pregnancy and 1,170 (0.60%) children developed either cerebral palsy or epilepsy. After adjusting for variables, the researchers found no overall association between antibiotics and cerebral palsy or epilepsy.

The researchers did, however, find that macrolides were associated with a 78% increased risk for cerebral palsy or epilepsy when compared with penicillin.

They also found that children of women who were prescribed three or more courses of antibiotics also had an elevated risk of cerebral palsy or epilepsy, but they believe that may be due to the reason for the antibiotic treatments rather than the antibiotics themselves.

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Macrolides During Pregnancy May Raise Cerebral Palsy, Epilepsy Risk

Between 19%-44% pregnant women are prescribed antibiotics during pregnancy. A single, large randomised-controlled-trial (ORACLE Childhood Study II) found an increased risk of childhood cerebral palsy and possibly epilepsy following prophylactic antibiotic use in pregnant women with spontaneous preterm labour. We ascertained whether this outcome could be reproduced across the population of babies delivered at term and prospectively followed in primary-care using data from The Health Improvement Network.

We found no overall association between antibiotic prescribing in pregnancy and cerebral palsy and/or epilepsy in childhood. However, our finding of an increased risk of cerebral palsy or epilepsy associated with macrolide prescribing in pregnancy adds to evidence that macrolide use is associated with serious harm.

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