抗生素通常是开给有先天缺陷的孕妇的

抗生素通常是开给有先天缺陷的孕妇的

A class of antibiotics commonly prescribed to pregnant women is associated with an increased risk of major birth deformities, particularly heart defects, when compared with penicillin, according to a study published in BMJ.

一项发表在《英国医学杂志》(BMJ)上的研究表明，与青霉素相比，一种常开给孕妇的抗生素会增加婴儿出生时出现严重畸形，尤其是心脏缺陷的风险。

Macrolides are a type of antibiotic derived from soil-born bacteria and used to treat common bacterial infections such as strep throat, particularly as an alternative for those with penicillin allergies. Known more commonly under the generic names of azithromycin, erythromycin, and clarithromycin, macrolides should be used with caution during pregnancy and only if alternatives are not available.

大环内酯类抗生素是一种从土壤细菌中提取的抗生素，用于治疗常见的细菌感染，如链球菌性咽喉炎，特别是作为青霉素过敏的替代。大环内酯类药物通常被称为阿奇霉素、红霉素和克拉霉素，只有在没有替代药物的情况下，怀孕期间应谨慎使用。

To assess the association between macrolides and major malformations of the heart and genitals, as well as four neurodevelopment disorders, researchers at University College London looked at data from more than 100,000 children born in the UK between 1990 and 2016 via the UK Clinical Practice Research Datalink, a national database that covers around 7 percent of the UK population. They also analyzed another 82,314 children whose mothers were prescribed one macrolide or penicillin before pregnancy and more than 53,000 of their siblings. Almost one-third of mothers in the population were prescribed at least one antibiotic during pregnancy; penicillin and macrolides accounted for about 69 and 10 percent of all prescriptions, respectively.

评估大环内酯类之间的关系和主要的心脏和生殖器畸形,以及四个神经发育障碍,伦敦大学的研究人员通过“英国临床实践研究数据链”研究了10万多名1990年至2016年出生在英国的儿童的数据。“英国临床实践研究数据链”是一个全国性数据库，覆盖了英国约7%的人口。他们还分析了82314名母亲在怀孕前服用大环内酯或盘尼西林的儿童及其53000多名兄弟姐妹。人口中近三分之一的母亲在怀孕期间至少服用一种抗生素;青霉素和大环内酯分别占处方总量的69%和10%。

When accounting for other influencing factors, researchers found that macrolides in the first trimester of pregnancy were associated with an increased risk of major malformations compared with penicillin, specifically those of the cardiovascular system. Children were also slightly more likely to be at risk of genital malformations. In all, about 2.1 percent of children born to more than 8,600 mothers prescribed macrolides were born with a major defect compared with 1.7 percent of children whose mothers were given penicillin. Researchers did not reveal a link to macrolide use and neurodevelopment disorders like cerebral palsy, epilepsy, ADHD, and autism spectrum disorder.

当考虑到其他影响因素时，研究人员发现，与盘尼西林相比，怀孕前三个月的大环内酯类药物与重大畸形的风险增加有关，尤其是心血管系统。儿童患生殖器畸形的可能性也略高一些。总的来说，在8600多名母亲使用大环内酯类药物所生的孩子中，大约2.1%的孩子在出生时就有严重缺陷，而在母亲使用青霉素的孩子中，这一比例为1.7%。研究人员没有揭示大环内酯类药物的使用与神经发育障碍，如脑瘫、癫痫、多动症和自闭症谱系障碍之间的联系。

Macrolides are commonly prescribed to treat bacterial infections, such as strep throat. Sherry Yates Young/Shutterstock

"Macrolide antibiotics are used to treat a wide variety of bacterial infections, and are among the most frequently prescribed antibiotics during pregnancy in Western countries,” said lead author, PhD candidate Heng Fan in a statement.

“大环内酯类抗生素用于治疗多种细菌感染，是西方国家孕期最常用的抗生素之一，”该研究的第一作者、博士生王帆在一份声明中说。

"This work builds on previous evidence of rare but serious adverse outcomes of macrolide use, especially for unborn babies. These adverse outcomes were assumed to be associated with the arrhythmic effect of macrolides and policy advice about their use in pregnancy varies."

这项研究建立在先前的证据基础上，这些证据表明使用大环内酯会产生罕见但严重的不良后果，尤其是对未出生的婴儿。这些不良结果被认为与大环内酯类药物的心律失常效应有关，而有关其在妊娠期使用的政策建议各不相同。”

Because it is an observational study, the researchers are quick to caution that a cause cannot be determined by their work. If future studies determine a causal link, Fan adds that an estimated four in every 1,000 children born to mothers prescribed macrolides in the first trimester would be born with cardiovascular malformations.

由于这是一项观察性研究，研究人员很快警告说，病因不能由他们的工作来确定。如果未来的研究确定了因果关系，范补充说，估计每1000个孩子中就有4个是在怀孕前三个月服用大环内酯的母亲所生的。

"Our findings suggest it would be better to avoid macrolides during pregnancy if alternative antibiotics can be used,” said Professor Ruth Gilbert of UCL Great Ormond Street Institute of Child Health. "Women should not stop taking antibiotics when needed, as untreated infections are a greater risk to the unborn baby."

伦敦大学学院大奥蒙德街儿童健康研究所的鲁思·吉尔伯特教授说:“我们的发现表明，如果可以使用替代抗生素，怀孕期间最好避免使用大环内酯类药物。”“女性不应该在需要的时候停止服用抗生素，因为未经治疗的感染对胎儿的风险更大。”