ArticleBMJ (Clinical research ed.)2021
Association between use of macrolides in pregnancy and risk of major birth defects: nationwide, register based cohort study.
Article in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Does early pregnancy exposure to macrolide antibiotics lead to major birth defects? A systematic review and meta-analysis.Frontiers in public health · 2026Pooled it
- Use of sensitivity analyses to assess uncontrolled confounding from unmeasured variables in observational, active comparator pharmacoepidemiologic studies: a systematic review.American journal of epidemiology · 2025Pooled it
- Prenatal Azithromycin Exposure and Risk of Neurodevelopmental Disorders in Children.JAMA network open · 2026Article
- A review of antibiotic safety in pregnancy-2025 update.Pharmacotherapy · 2025Review
- First-trimester exposure to macrolides and risk of major congenital malformations compared with amoxicillin: A French nationwide cohort study.PLoS medicine · 2025Article
- Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China.PLoS neglected tropical diseases · 2025Article
- Effect of preconception antibiotics exposure on female reproductive health and pregnancy outcomes: a systematic review and meta-analysis.EClinicalMedicine · 2024Article
- [Ophthalmic agents during pregnancy].Die Ophthalmologie · 2024Review
- Article
- Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review.Dermatology and therapy · 2023Review
- A medication-wide association study (MWAS) on repurposed drugs for COVID-19 with Pre-pandemic prescription medication exposure and pregnancy outcomes.Scientific reports · 2022Article
- Use of Azithromycin in Pregnancy: More Doubts than Certainties.Clinical drug investigation · 2022Review
- Association Between First-Trimester Maternal Cytomegalovirus Infection and Stillbirth: A Prospective Cohort Study.Frontiers in pediatrics · 2022Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the association between the use of macrolide antibiotics in pregnancy and the risk of major birth defects.
designNationwide, register based cohort study.
settingDenmark, 1997-2016.
participantsOf 1 192 539 live birth pregnancies, pregnancies during which macrolides had been used (13 019) were compared with those during which penicillin (that is, phenoxymethylpenicillin) had been used (matched in a 1:1 ratio on propensity scores). Other comparative groups were pregnancies when macrolides had been used recently but before pregnancy (matched 1:1) and pregnancies where no antibiotics had been used (matched 1:4).
main outcome measuresAssociation with an outcome of any major birth defect and specific subgroups of birth defects were assessed by relative risk ratios and absolute risk differences.
resultsIn matched comparisons, 457 infants were born with major birth defects to women who had used macrolides during pregnancy (35.1 per 1000 pregnancies) compared with 481 infants (37.0 per 1000 pregnancies) to women who had used penicillin (relative risk ratio 0.95; 95% confidence interval 0.84 to 1.08), corresponding to an absolute risk difference of -1.8 (95% confidence interval -6.4 to 2.7) per 1000 pregnancies. The risk of major birth defects was not significantly increased for women who had used macrolides during pregnancy compared with those who had used macrolides recently but before becoming pregnant (relative risk ratio 1.00 (95% confidence interval 0.88 to 1.14); absolute risk difference -0.1 (95% confidence interval -4.8 to 4.7) per 1000 pregnancies) or compared with women who did not use any antibiotics (1.05 (0.95 to 1.17); 1.8 (-1.7 to 5.3) per 1000 pregnancies). For all three comparative group analyses and in the analyses of use of individual macrolides, no significant increased risk of specific subgroups of birth defects associated with the use of macrolides was found.
conclusionsIn this nationwide cohort study, the use of macrolide antibiotics in pregnancy was not associated with an increased risk of major birth defects. Analyses of the associated risk of 12 specific subgroups of birth defects with the use of macrolides in pregnancy were not significant.
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