Effect of Antimicrobial Exposure in Pregnancy on Adverse Pregnancy Outcomes and Admission Rate to the Neonatal Intensive Care Unit: A Multi-Center Cohort Study

Abstract

Purpose

Antimicrobial agents are frequently prescribed during pregnancy. This study aims to explore the association between antimicrobial exposure and pregnancy outcomes.

Patients and Methods

A multi-center retrospective cohort study of pregnant patients (n=370) was conducted in 22 tertiary hospitals in China. Adverse pregnancy outcomes and admission of neonate to neonatal intensive care unit (NICU) were considered as outcomes. The effect of antimicrobial exposure on pregnancy outcomes was assessed using a multivariate logistic regression model.

Results

Use of first-generation cephalosporins during pregnancy was associated with a significantly higher risk of adverse pregnancy outcomes (odds ratio [OR]: 3.64 [95% confidence interval, CI: 1.43–9.24], P = 0.007) and admission of neonate to the NICU (OR: 3.41, 95% CI: 1.37–8.53, P=0.009) compared with use of third-generation cephalosporins, after adjusting for gestational age of exposure to antimicrobial agents, cesarean section, and antimicrobial dose. Similarly, a higher risk of adverse pregnancy outcomes (OR: 14.76, 95% CI: 4.43–49.11) and neonatal NICU admission (OR: 11.74, 95% CI: 3.59–38.35) were observed among women with first-generation cephalosporins use compared with mothers with no antimicrobial use.

Conclusion

Both first- and third-generation cephalosporins use was associated with an increased risk of adverse pregnancy and neonatal outcomes. In addition, first-generation cephalosporins were associated with an increased risk of those pregnant and neonatal outcomes, when compared with third-generation cephalosporins. We should require to determine the indications and contraindications for use of cephalosporins during pregnancy.

Keywords:

• maternal infections
• antimicrobial agents
• adverse pregnancy outcomes
• NICU
• cephalosporin

Highlights

1. The retrospective cohort study showed effects of antimicrobial on pregnant women.

2. Cephalosporins were the most commonly used antimicrobial drugs during pregnancy.

3. Use of first-generation cephalosporins was risky for adverse pregnancy outcomes.

Ethical Approval Statement

This research was approved by the Ethics Committee of Department of Obstetrics and Gynecology affiliated to Fudan University (2020-131). All data are available at the ResMan Manager of Chinese Clinical Trial Registry (Registration number: ChiCTR2100044398). Informed consents were obtained.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

There are no conflicts of interest to disclose.

Additional information

Funding

The research was supported by the project of health industry research of the Shanghai Municipal Health Commission (201940153).