Young pregnant woman holding blister pack of medicine tablets c
gettyThe last two years have not been kind to anyone, but perhaps especially pregnant individuals. With fears and concerns about the potential risks of getting Covid while pregnant, and whether or not pregnant women should get the vaccine (spoiler alert: they should), it’s been a scary time to be bringing new babies into the world.
But with so many pregnancy fears orbiting around Covid this last few years, some may have forgotten that every cough and sniffle isn’t necessarily Covid-related. And treating other illnesses requires additional consideration for pregnant individuals as well.
Particularly when it comes to whether to take antibiotics to treat those infections.
Pregnancy and Antibiotics: Are They Safe?
Lucky Sekhon, MD, is a double board-certified fertility doctor and OBGYN. She says that antibiotics can be safe when taken during pregnancy, depending on the medication itself. And more importantly, just like the Covid-19 vaccine, the benefits of taking antibiotics while pregnant often outweigh and potential risks.
“It could be unsafe to under-treat or fail to medically treat infection while pregnant, as this could then become a more severe infection,” Sekhon explained.
Of course, knowing which antibiotics to take and when is an important part of the equation. According to general family physician Navya Mysore, MD, “It is safe to take certain antibiotics in pregnancy, but there is a list which are safe in pregnancy and this list can change depending on how far along you are or which trimester you are in.”
To help track which antibiotics are safe during pregnancy and which aren’t, the American College of Clinical Pharmacy (ACCP) follows the Food and Drug Administration’s (FDA) pregnancy category ratings:
- A: Medications that have shown no risk to the fetus or the pregnant person in human studies
- B: Medications that have shown no risk in animal studies, but haven’t been tested in human studies, and should therefore be used in pregnancy only when clearly indicated
- C: Medications that have shown some adverse effects in animal studies, and have no clear human studies, making these medications that should only be used in pregnancy when there are no better options
- D: Medications that have shown positive evidence of risk in human trials, risks the pregnant patient should be made fully aware of before taking (drugs in this category should be avoided during pregnancy if possible)
- X: Medications that are contraindicated in pregnancy and could pose a serious risk of fetal abnormalities
When taking and prescribing antibiotics during pregnancy, these ratings are important to pay attention to.
Possible Complications
All antibiotics pose some potential complications whether a patient is pregnant or not. But some are generally safer than others. Those in categories A and B present the fewest potential complications for a patient and fetus.
Sekhon said that potential complications ultimately depend on the antibiotic itself.
“There are some that have been shown to lead to a higher rate of birth defects and cancers in animal studies, which have not been confirmed in human studies,” she explained. “Other antibiotics, such as streptomycin, are known to pose a risk of hearing loss in babies exposed in utero.”
But there are also antibiotics that fall into those first few categories and pose very little risk of complication. As well as those that are only considered safe in certain trimesters.
As Mysore explained, “There are some that are safer than others and some antibiotics that are safer in a certain trimester but not in another. Examples are penicillin and cephalexin (keflex) which are considered safe in every trimester versus sulfa antibiotics which are generally safe in the second and third trimester but not in the first trimester.”
For all these reasons, it’s important that a pregnant person inform their doctor and pharmacist that they are pregnant before starting any new antibiotics. In this way, they can discuss potential risks together and choose the safest possible antibiotic to use.
Discovering You’re Pregnant While on Antibiotics
Of course, pregnancy isn’t always planned. And there are occasions when a person may discover they are pregnant while already taking certain antibiotics.
What then?
“I think this would depend on which antibiotic they are taking and what they are taking it for,” Mysore said. “If it’s an antibiotic that is safe in pregnancy, there is no harm in completing the course.”
But what if it’s a medication that isn’t deemed safe for pregnancy?
“If, for example, you are taking antibiotics for acne treatment, it might be a medication you are ok to stop versus if you are taking an antibiotic to treat a UTI or a bacterial sinus infection,” Mysore said. “Bottom line, I would suggest reaching out to your primary care provider to help navigate the decision with the medication you are taking.”
There’s no reason to panic, though. Just pick up the phone and call your doctor as soon as you find out you are pregnant. From there, you can decide together what the best course of action may be.
Questions to Ask
If you are being prescribed antibiotics while pregnant, it is perfectly acceptable to ask questions and advocate for yourself and your baby.
“Especially if it’s not your OB’s office who is prescribing the medication,” Mysore said.
She recommends asking whether the medication is identified as safe for the trimester you are in. And if it’s a necessary medication and isn’t a Category A drug, she said you should also ask what the potential risks may be.
“If your provider is not sure, do not hesitate to bring it back to your OB to get their opinion,” she said.
Sekhon agreed, adding, “Pregnancy category C medications should be avoided and only taken if needed and the potential risks are outweighed by the benefits. It is also important to know if there is a better alternative antibiotic which you can be switched to.”
The good news is that often with antibiotics, there are alternatives that can be considered.
“Being pregnant does not mean you need to avoid medications (antibiotics) at all costs,” Sekhon said. “Talk to your doctor about the pros and cons of any medications that you are considering taking in early pregnancy.”
And take care of yourself while you’re at it. One way to do this, according to Mysore, is to always take a probiotic while on antibiotics—whether you are pregnant or not. This can help to prevent some of the potential, unpleasant side effects of antibiotics like yeast infections. Something no one wants to deal with, but especially not while pregnant.
Many antibiotics are considered generally safe to take during pregnancy, while others can pose risks to a developing baby.
Antibiotics are often prescribed if you're sick with a bacterial infection. While no medication is 100-percent free of possible side effects, many antibiotics are considered safe for pregnant women. When your healthcare provider is considering prescribing an antibiotic, they'll go over any potential risks with you. Not treating your illness could be riskier for your health and your baby's health than exposing them to an antibiotic.
As with any medication, the safety of a particular antibiotic depends not only on the drug itself, but also on other factors including how much you take, how long you take it, and how far along you are in your pregnancy.
Safe antibiotics in pregnancy
Some antibiotics that are generally considered safe during pregnancy include:
- Penicillins, including amoxicillin and ampicillin
- Macrolides, including erythromycin and azithromycin
- Cephalosporins, including cephalexin
- Metronidazole, which isn't an antibiotic but is used to treat some vaginal infections, such as trichomoniasis and bacterial vaginosis, as well as other kinds of infections
Studies on some of these antibiotics have found mixed conclusions on whether they can cause birth defects. It can be hard to determine for sure what caused a birth defect, as there are many factors in any given pregnancy, and an antibiotic is just one factor. The likelihood of these antibiotics causing problems for your baby is extremely low.
Antibiotics to use with caution
There are some antibiotics that have raised safety concerns in pregnancy, but may need to be used anyway. These include antibiotics commonly used to treat a urinary tract infection (UTI). UTIs are common during pregnancy and can cause complications if they go untreated.
Nitrofurantoin (Macrobid)
One common antibiotic for UTIs is nitrofurantoin (Macrobid). Nitrofurantoin has been associated with some birth defects. The American College of Obstetricians and Gynecologists recommends that providers avoid prescribing nitrofurantoin in the first trimester (when most fetal development takes place) to avoid possible birth defects.
Trimethoprim and sulfamethoxazole (Bactrim)
Trimethoprim is another antibiotic often found in drugs used to treat urinary tract infections (such as Bactrim and Septra). It is often combined with another antibiotic called sulfamethoxazole.
There have been many concerns about sulfamethoxazole and trimethoprim during pregnancy. Because these drugs have been associated with an increased risk of birth defects, this is another drug ACOG suggests avoiding in the first trimester of pregnancy.
Another reason trimethoprim may not be a good option during pregnancy is because it blocks the effects of folic acid. Folic acid is crucial during pregnancy and preconception because it reduces your baby's risk of developing neural tube and other birth defects.
If your healthcare provider prescribes trimethoprim, be sure to take your daily prenatal vitamin. It's possible that taking a daily folic acid supplement of at least 400 micrograms (prenatal vitamins generally contain twice this amount) can overcome the blocking effects of trimethoprim.
Antibiotics to avoid during pregnancy
Some antibiotics aren't prescribed during pregnancy because of the potential risks to the baby.
Tetracycline
Tetracycline (including minocycline, oxytetracycline, and doxycycline) is used to treat acne and respiratory infections. If you take tetracycline in the second or third trimester, it could discolor your developing baby's teeth, as well as interfere with the hardening of their bones and teeth. Experts suggest avoiding tetracycline after the fourth month of pregnancy.
Streptomycin
Streptomycin, which is used to treat tuberculosis, isn't recommended during pregnancy because it can cause hearing loss in your baby.
Ciprofloxacin
Ciprofloxacin is commonly prescribed for UTIs, but isn't prescribed during pregnancy because it can cause abnormal bone development in an unborn baby.
Reasons for antibiotics during pregnancy
Certain infections during pregnancy, if left untreated, can be dangerous for you and your baby. Some types of infections during pregnancy can reach your baby and have detrimental effects on the health of your fetus. Some untreated infections can also pose risks of miscarriage and preterm labor.
One reason you may be given antibiotics near the end of your pregnancy is if you test positive for Group B streptococcus (GBS) before delivery. GBS is a bacteria that can be found in your body and easily passed on to your baby. It can be dangerous for your baby since it can potentially cause meningitis, pneumonia, or sepsis. If you test positive for GBS or are suspected to have GBS, your provider will treat you with an IV antibiotic (often a penicillin) during labor.
Another reason you may be treated with antibiotics during labor is if your water breaks prematurely – before your pregnancy has reached term (especially before 34 weeks). Antibiotic treatment in this scenario can help prevent any infections from reaching your baby before delivery.
Things to consider when taking antibiotics during pregnancy
It's important to remember that birth defects, even those associated with antibiotic use, are rare. Sometimes the risk of your baby being exposed to an untreated infection is higher than the risk of being exposed to antibiotics in utero. Talk about any concerns with your healthcare provider and work together to make the best decisions for you and your baby.
If you do need to take antibiotics, only take them under the instructions of your healthcare provider. Your provider can help you determine if antibiotics are needed and whether the benefits of taking one outweigh any potential risk it may have for your baby.
Your provider will also let you know how much to take, and how long to take it for. Only take antibiotics as prescribed and never take someone else's antibiotics. If you aren't currently pregnant, but are trying to conceive or have any chance of being pregnant, let your healthcare provider know before starting an antibiotic.