A study published in JAMA Network Open suggests that prenatal azithromycin exposure is not associated with neurodevelopmental disorders in children. Late pregnancy use was linked to lower risks.
A retrospective cohort study conducted by Xuerong Wen and colleagues from the University of Rhode Island has found no significant association between azithromycin exposure during pregnancy and neurodevelopmental disorders in offspring, according to a report published in JAMA Network Open. The research, which analyzed data on over 15,000 mother-infant pairs with a mean follow-up period of 5.5 years, revealed that prenatal azithromycin use was not linked to any neurodevelopmental disorder compared to no exposure or other antibiotic exposures.
The study found that exposure to azithromycin at any point during pregnancy did not increase the risk of neurodevelopmental disorders in children. Notably, prenatal azithromycin exposure in late pregnancy (from 20 weeks' gestation to delivery) was associated with a lower risk of overall neurodevelopmental disorders compared to exposure to other antibiotics, with an adjusted hazard ratio (aHR) of 0.69 and a confidence interval (CI) of 0.49-0.98. Additionally, late pregnancy azithromycin use was linked to a reduced risk of speech and language disorder by an aHR of 0.59 with a CI of 0.39-0.91.
The researchers prenatal azithromycin exposure in late pregnancy may confer neuroprotective effects due to its enhanced anti-inflammatory properties, which could be particularly beneficial during the rapid brain development phase. Wen and colleagues expressed surprise at their findings, especially considering the decreasing trend of azithromycin prescriptions for pregnant women driven by concerns about antibiotic resistance.
The study's population showed that only 4.8% of mother-infant pairs were exposed to azithromycin, while 19.8% were exposed to other antibiotics and 75.4% had no antibiotic exposure during pregnancy. Despite this, Wen emphasized that the drug could be prescribed with caution in later stages of pregnancy.
Dani Dumitriu, MD, Ph.D., from Columbia University highlighted the importance of building an empirical basis for prescribing medications to pregnant women based on accumulating evidence indicating a link between maternal inflammation and fetal development through the placenta. The study's most significant finding was that there was no risk associated with azithromycin exposure during pregnancy.
Wen cautioned about the low number of cases of autism spectrum disorder (ASD), noting that while late pregnancy use of azithromycin was linked to a lower risk of ASD compared to no antibiotic exposure, this effect might be due to chance. The study's limitations included potential unmeasured factors influencing results and the fact that it only included commercially insured patients.
The findings suggest that clinicians could consider using azithromycin with caution in later stages of pregnancy, potentially offering neuroprotective benefits without compromising maternal health or fetal safety. Further research is needed to explore the mechanisms behind these protective effects and to ensure broader applicability across different populations.
