Preconception Antibiotic Use may Increase Infertility, Miscarriages, and Congenital Malformations Risk: Study

A recent systematic review and meta-analysis revealed the significant impact of preconception antibiotic use on maternal and pregnancy outcomes, highlighting the potential risks to fertility, miscarriage rates, and congenital anomalies. The key findings of this study were published in the recent issue of Lancet eClinicalMedicine.

The research involved over 1.2 million participants across 15 studies and illuminates the importance of cautious antibiotic prescription and use during the preconception period. The study explored the effects of several antibiotic classes on reproductive health. 

Women who were exposed to macrolides before conception had a 35% reduction in fecundability ratios (FR: 0.65), indicating a significant negative impact on their ability to conceive. Usage of this class of antibiotics increased the risk of infertility by over two times (Odds Ratio [OR]: 2.35). These results suggest that sulfonamides may significantly impair female reproductive health.

Also, beta-lactams demonstrated a protective effect, reducing the odds of infertility by 64% (OR: 0.36). This finding points to variability in the reproductive impacts of different antibiotics. Exposure to quinolones showed a marginal reduction in the risk of infertility (OR: 0.87), suggesting they may pose a lower risk when compared to other antibiotic types.

Notably, trimethoprim intake was associated with an 85% increased risk of congenital malformations (OR: 1.85), raising alarms about its safety during the preconception period. Antibiotic exposure overall increased the risk of miscarriage by 34% (Relative Risk [RR]: 1.34), highlighting the potential dangers of using certain antibiotics before pregnancy.

This study highlights the need for clinicians and prospective mothers to exercise caution with antibiotics during the preconception phase. While some antibiotics like beta-lactams and quinolones may have a lesser impact, others, particularly macrolides, sulfonamides, and trimethoprim, are linked to adverse reproductive outcomes.

The findings emphasized the necessity of additional clinical and mechanistic studies to clarify the underlying biological effects of these antibiotics on fertility and pregnancy outcomes. Also, awareness campaigns and stricter protocols for prescribing antibiotics during the preconception phase could play a pivotal role in mitigating risks and improving pregnancy success rates. Overall, the preconception period is a critical window for influencing maternal and fetal health. Thoughtful and informed antibiotic use is paramount for protecting reproductive health and ensuring the well-being of future generations.

Reference:

Alemu, B. K., Wang, C. C., Li, L., Zhu, Z., Li, Q., & Wang, Y. (2024). Effect of preconception antibiotics exposure on female reproductive health and pregnancy outcomes: a systematic review and meta-analysis. In eClinicalMedicine (Vol. 78, p. 102935). Elsevier BV. https://doi.org/10.1016/j.eclinm.2024.102935