Evidence map›Paper›PMID 42118534›Full record

ArticleJAMA network open2026

Prenatal Azithromycin Exposure and Risk of Neurodevelopmental Disorders in Children.

Marianne N Otoo, Kimford J Meador, Todd Brothers, Thomas Lavoie, Nicole J Asal, Brian J Quilliam, Don Keon Yon, Carmen Monthe-Dreze, Kristina E Ward, Jing Wu and 2 more

Erratum issuedAbstract read
In one paragraph

Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Error in Byline.JAMA network open · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Marianne N OtooDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Kimford J MeadorDepartment of Neurology and Neurological Sciences, Stanford University, Palo Alto, California.
Todd BrothersDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Thomas LavoieDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Nicole J AsalDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Brian J QuilliamDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Don Keon YonCenter for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
Carmen Monthe-DrezeDepartment of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Kristina E WardDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.
Jing WuDepartment of Computer Science and Statistics, University of Rhode Island, Kingston.
Adam K LewkowitzDepartment of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Xuerong WenDepartment of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Azithromycin is commonly used during pregnancy to treat bacterial infections, but its effects on neurodevelopmental disorders (NDDs) remain inconclusive. Objective: To evaluate the risk of NDDs in children prenatally exposed to azithromycin compared with those exposed to other antibiotics or with no antibiotic exposure during gestation. Design, Setting, and Participants: This retrospective cohort study used data from an administrative health claims database (January 1, 2012, to October 31, 2024). The study evaluated a mother-infant cohort of mothers aged 12 to 55 years with a live birth between December 1, 2012, and December 31, 2023, who filled at least 1 prescription for an antibiotic or were unexposed to antibiotics during pregnancy. Mothers with antibiotic exposure within 90 days before pregnancy were excluded. Exposures: Propensity scores were used to match children exposed to azithromycin with those exposed to other antibiotics or no antibiotics during the entire, early, and late pregnancy periods. Main Outcomes and Measures: Cox proportional hazards regression models were applied to assess the incidence of NDDs, including attention-deficit/hyperactivity disorder, autism spectrum disorder, speech and language disorder (SLD), developmental coordination disorder, and behavioral disorders, during follow-up, in the azithromycin cohort compared with those exposed to other antibiotic classes or those with no antibiotic exposure. Results: Among 15 527 mother-infant dyads (mean [SD] maternal age, 32.4 [4.1] years) included in this study, 742 (4.8%) were exposed to azithromycin, 3079 (19.8%) were exposed to other antibiotics, and 11 706 (75.4%) remained unexposed to antibiotics during pregnancy. After a mean (SD) follow-up of 5.5 (3.0) years, late pregnancy azithromycin exposure was associated with a lower risk of SLD compared with those unexposed (adjusted hazard ratio [AHR], 0.61; 95% CI, 0.39-0.94) as well as a lower risk of overall NDDs (AHR, 0.69; 95% CI, 0.49-0.98) and SLD (AHR, 0.59; 95% CI, 0.39-0.91) compared with those exposed to other antibiotics. Conclusions and Relevance: In this cohort study, late pregnancy azithromycin exposure was associated with a lower risk of NDDs, particularly SLDs. However, azithromycin prescribing during pregnancy should remain guided by clinical necessity and existing safety recommendations; further studies using larger and more diverse populations are warranted to confirm these findings.

Indexed as

Anti-Bacterial AgentsAzithromycinNeurodevelopmental DisordersPrenatal Exposure Delayed EffectsAdolescentAdultChildFemaleHumansMaleMiddle AgedPregnancyRetrospective StudiesYoung AdultAnti-Bacterial AgentsAzithromycin

Identifiers

PMID42118534
PMCPMC13169396

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.