Antibiotics During Pregnancy: A Few Things to Know

Is it safe to take antibiotics during pregnancy? This is a commonly asked question that many women who are pregnant or thinking about being pregnant might have. When pregnant, a woman is very careful about what she puts into her body and does her best to avoid getting an infection or becoming ill. Unfortunately, this is not always preventable. We decided to sit down with Christopher Bloss, MD, an OB/GYN with Capital Region Women’s Care and the Interim Medical Director at Burdett Birth Center. In our Q&A, we talked with him about ways to prevent infection during pregnancy, antibiotics and safety during pregnancy and other best practices.

Pregnant women are very careful about what they eat, drink and do with their bodies. However, pregnant women are more susceptible to infection. Why is that?

There are several factors. Their immune system is more “tolerant” as it has to be able to “tolerate” an organism growing that is only half genetically similar to the mother. This allows bacteria and viruses the opportunity to “get ahold” where they usually wouldn’t. Decreased lung volumes and decreased transport of urine increase the possibility of pneumonia and urinary tract infections.  The volume of the placenta in close proximity to the rich bacterial environment of the vagina provides a place where bacteria can grow. Pregnant women are at particular risk for infections with influenza, hepatitis E, herpes, malaria, measles, smallpox, varicella (chickenpox), coccidioidomycosis (a fungus), and toxoplasmosis.

Do you have any advice or best practices for women to help prevent infections during pregnancy?

There are several things women can do to help to prevent infections during pregnancy.  Get your flu shot! There is a lot of misinformation about safety of the flu shot. The current flu shot is an inactivated flu virus, which means you cannot get the flu from the vaccine. It is like getting an envelope with no letter inside. When your body receives the envelope again, this time with a letter inside, the immune system knows to react to it.

In addition, getting a flu shot will help to protect the baby. Thanks to the H1N1 flu about a decade ago, we have good long-term safety data for moms and babies. Babies are not eligible for a flu shot until they are 6 months of age. By getting the flu shot during pregnancy, a woman’s body will make antibodies which the placenta will actively transport into the baby.  These antibodies will help protect the baby. If a mother plans to breastfeed, these antibodies will continue to be transmitted to the baby.  Prior to pregnancy, a woman should make sure she is up-to-date with her MMR and varicella vaccines as these are live vaccines.

Here is a list of other things that women can do during pregnancy to avoid infections from the American Academy of Pediatrics.

What happens if a bacterial infection is not treated during pregnancy?  

A pregnant woman is more likely to get sicker and develop sepsis (a system infection) or die if a bacterial infection is not treated. In addition, the fetus could get sick and a miscarriage or preterm birth could result.

Viral infections include the common cold and the flu. Why should these not be treated with antibiotics?

Viruses do not respond to antibiotics and your body will typically resolve a viral infection within 1-2 weeks with only supportive medical care.

Which antibiotics are safe during pregnancy?

Several antibiotics are safe during pregnancy.  These include penicillin’s, cephalosporins, macrolides such as erythromycin, and clindamycin.  Other antibiotics may be used depending on which trimester you are in.

Are there other factors that affect the safety of taking an antibiotic during pregnancy? (When in your pregnancy a woman takes the antibiotic, how much you take, possible side effects, length of prescription, etc.)

The main factor is what trimester a woman is in as some antibiotics can affect the development of the organs (organogenesis).

With many conflicting headlines out there, a lot of expecting moms may wonder: can taking antibiotics while pregnant hurt the baby?

The American College of Obstetrics and Gynecology (ACOG) put out a Committee Opinion in September 2017 addressing the uses of antibiotics during pregnancy and risk for birth defects.  ACOG states:

“Commonly used antibiotics, such as penicillin’s (including ampicillin and amoxicillin), erythromycin, and cephalosporins, have not been found to be associated with an increased risk of birth defects.  However, the evidence regarding an association between the nitrofurantoin and sulfonamide classes … is mixed. Prescribing sulfonamides (sulfa drugs like Bactrim or Septra) or nitrofurantoin (Macrobid) during the first trimester is still considered appropriate when no other suitable alternative antibiotics are available.  During the second and third trimesters, sulfonamides and nitrofurantoin’s may continue to be uses as first line agents for the treatment and prevention of urinary tract infections and other infections…”

Other antibiotics such as gentamicin, ciprofloxacin, and metronidazole are also considered safe.  Tetracyclines are not used during pregnancy due to risk for problems with bone and tooth development. Use of antibiotic eye drops for pink eye or ear drops for ear infection are okay to use.

Overall, what advice can you offer pregnant moms about taking antibiotics during pregnancy?

Always ask your obstetrician.  If prescribed an antibiotic, make sure to take the entire course so you don’t have an incompletely treated infection.

We interviewed Christopher Bloss, MD as part of our series of blog articles about the doctors, midwives, nurses and other providers at Burdett Birth Center. Read his profile to get to know him a little better.

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