Macrolides in pregnancy leads to Higher Birth Defects Risk
Children whose mothers were prescribed macrolide antibiotics during pregnancy had a higher risk of malformations compared with children whose mothers were prescribed penicillin, according to a population-based cohort study.

Mothers that were prescribed macrolide antibiotics -- such as erythromycin, clarithromycin, or azithromycin -- during the first trimester of pregnancy had offspring more likely to develop a major malformation versus mothers that were prescribed penicillin

Macrolides are a class of antibiotics used to treat bacterial infections, and are often prescribed as an alternative for patients allergic to penicillin. Although macrolides are commonly prescribed, and erythromycin specifically is considered safe for pregnant women, further evidence suggests that providers should prescribe macrolides with caution.
Findings were not significant when restricted to first trimester prescribingThere was no association between macrolide prescribing during pregnancy and presence of cerebral palsy, epilepsy, ADHD, or ASD

Prescribing macrolide antibiotics during the first trimester of pregnancy was associated with an increased risk of any major malformation and specifically cardiovascular malformations compared with penicillin antibiotics. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations. These findings show that macrolides should be used with caution during pregnancy and if feasible alternative antibiotics should be prescribed until further research is available

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