Fetus-Placenta-Newborn
Use of cephalosporins during pregnancy and in the presence of congenital abnormalities: A population-based, case-control study,☆☆

https://doi.org/10.1067/mob.2001.113905Get rights and content

Abstract

Objective: Our purpose was to study the human teratogenic potential of cephalosporin treatment during pregnancy. Study Design: Pair analysis of cases with congenital abnormalities and matched controls without congenital abnormalities was performed. The population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996, was used. The participants included 22,865 pregnant women who had fetuses or newborn infants with congenital abnormalities, 38,151 pregnant women who had infants without any defects (population control group), and 812 mothers who were delivered of babies affected with Down syndrome (patient controls). Results: In the case group, 308 (1.35%) pregnant women were treated with cephalosporin. In the population and patient control groups, 440 (1.15%) and 16 (1.97%) pregnant women had similar treatments. The somewhat higher use of cephalosporins, mainly oral cephalexin, in the case and patient control groups was explained by recall bias. The comparison of the occurrence of medically documented cephalosporin treatments during the second to third months of gestation (ie, the critical period for major congenital abnormalities) in different congenital abnormality groups with the referent data of the total population control group and the patient control group did not indicate a detectable human teratogenic potential of the studied drug. Conclusion: Treatment with the studied cephalosporins during pregnancy does not seem to present a detectable teratogenic risk to the fetus. However, further studies are needed to clarify the teratogenic and fetal toxic effects of different cephalosporins separately. (Am J Obstet Gynecol 2001;184:1289-96.)

Section snippets

Material and methods

The Hungarian Congenital Abnormality Registry (HCAR) is a nationally based registry of cases with congenital abnormalities.5 Notification of congenital abnormalities is compulsory for physicians, mainly obstetricians (in Hungary almost all deliveries take place in inpatient obstetric clinics) and pediatricians. Autopsy was obligatory for all infant deaths during the study period, and pathologists sent a copy of the autopsy record to the HCAR in cases of death (stillbirths and infant deaths

Results

The number of total births was 2,146,574 in Hungary during the study period; 38,151 population controls therefore represented 1.8% of Hungarian births. The case group consisted of 22,865 malformed offspring, whereas patient controls with Down syndrome included 812 offspring (Table I). The use of total cephalosporins was slightly higher in the case group (1.35%) than in the population controls (1.15%); this difference is explained mainly by the higher use of cephalexin in the case group. The

Comment

Cephalosporins belong to the β-lactam antibiotics, and they can inhibit the bacterial membrane’s synthesis.1, 2, 3 Cephalosporins were used mainly for the treatment of acute maternal diseases of the urinary tract and respiratory system of pregnant women.

This study compared the use of 7 cephalosporin treatments during pregnancy in the group of cases with congenital abnormalities, their matched healthy population, and the affected patient controls, and the results did not indicate a teratogenic

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Supported in part by EuroMap concerted action in the Biomed 2 Workprogramme contract No. BMH4-97-2430 and by Danish Medical Research Council grant No. 9700 677.

☆☆

Reprint requests: Andrew E. Czeizel, MD, PhD, Department of Human Genetics, National Center for Epidemiology, Foundation for the Community Control of Hereditary Diseases, Törökvész lejtö 32, Budapest 1026, Hungary.

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