A systematic review and meta-analysis, published in Lancet eClinicalMedicine, underscores the significant influence of preconception antibiotic use on maternal and pregnancy outcomes. The study reveals concerning risks associated with fertility, miscarriage rates, and congenital anomalies, calling for greater caution in antibiotic prescriptions during this critical period.
The research, which analyzed data from over 1.2 million participants across 15 studies, highlights the varying impacts of different antibiotic classes on reproductive health.
Key findings include a notable 35% reduction in fecundability among women exposed to macrolides before conception (Fecundability Ratio [FR]: 0.65). This antibiotic class also doubled the risk of infertility (Odds Ratio [OR]: 2.35), underscoring its potential to impair female reproductive health. Sulfonamides, similarly, were identified as significant disruptors of fertility.
Conversely, beta-lactams demonstrated a protective effect, reducing infertility risk by 64% (OR: 0.36). Exposure to quinolones showed a marginally lower impact, with an OR of 0.87, indicating they may present fewer risks compared to other antibiotics.
However, trimethoprim raised particular concerns, with an 85% increased risk of congenital malformations (OR: 1.85). Moreover, overall antibiotic exposure prior to pregnancy elevated miscarriage risk by 34% (Relative Risk [RR]: 1.34).
These findings call for heightened awareness and stricter prescribing protocols during the preconception phase. While some antibiotics, such as beta-lactams and quinolones, may pose a lower risk, others—including macrolides, sulfonamides, and trimethoprim—are linked to serious adverse effects on fertility and fetal health.
The study also emphasizes the need for further clinical and mechanistic research to elucidate the biological pathways through which antibiotics affect reproductive outcomes. Public awareness campaigns and careful management of antibiotic use during the preconception period could play a vital role in reducing risks and improving pregnancy success rates.
Ultimately, the preconception period represents a pivotal opportunity to safeguard maternal and fetal health. Thoughtful, evidence-based antibiotic use is essential to ensuring reproductive well-being and protecting future generations.
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