抗生素通常是開給有先天缺陷的孕婦的

抗生素通常是開給有先天缺陷的孕婦的

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.

一項發(fā)表在《英國醫(yī)學雜志》(BMJ)上的研究表明，與青霉素相比，一種常開給孕婦的抗生素會增加嬰兒出生時出現(xiàn)嚴重畸形，尤其是心臟缺陷的風險。

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.

大環(huán)內酯類抗生素是一種從土壤細菌中提取的抗生素，用于治療常見的細菌感染，如鏈球菌性咽喉炎，特別是作為青霉素過敏的替代。大環(huán)內酯類藥物通常被稱為阿奇霉素、紅霉素和克拉霉素，只有在沒有替代藥物的情況下，懷孕期間應謹慎使用。

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.

評估大環(huán)內酯類之間的關系和主要的心臟和生殖器畸形,以及四個神經發(fā)育障礙,倫敦大學的研究人員通過“英國臨床實踐研究數據鏈”研究了10萬多名1990年至2016年出生在英國的兒童的數據。“英國臨床實踐研究數據鏈”是一個全國性數據庫，覆蓋了英國約7%的人口。他們還分析了82314名母親在懷孕前服用大環(huán)內酯或盤尼西林的兒童及其53000多名兄弟姐妹。人口中近三分之一的母親在懷孕期間至少服用一種抗生素;青霉素和大環(huán)內酯分別占處方總量的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.

當考慮到其他影響因素時，研究人員發(fā)現(xiàn)，與盤尼西林相比，懷孕前三個月的大環(huán)內酯類藥物與重大畸形的風險增加有關，尤其是心血管系統(tǒng)。兒童患生殖器畸形的可能性也略高一些?？偟膩碚f，在8600多名母親使用大環(huán)內酯類藥物所生的孩子中，大約2.1%的孩子在出生時就有嚴重缺陷，而在母親使用青霉素的孩子中，這一比例為1.7%。研究人員沒有揭示大環(huán)內酯類藥物的使用與神經發(fā)育障礙，如腦癱、癲癇、多動癥和自閉癥譜系障礙之間的聯(lián)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.

“大環(huán)內酯類抗生素用于治療多種細菌感染，是西方國家孕期最常用的抗生素之一，”該研究的第一作者、博士生王帆在一份聲明中說。

"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."

這項研究建立在先前的證據基礎上，這些證據表明使用大環(huán)內酯會產生罕見但嚴重的不良后果，尤其是對未出生的嬰兒。這些不良結果被認為與大環(huán)內酯類藥物的心律失常效應有關，而有關其在妊娠期使用的政策建議各不相同。”

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.

由于這是一項觀察性研究，研究人員很快警告說，病因不能由他們的工作來確定。如果未來的研究確定了因果關系，范補充說，估計每1000個孩子中就有4個是在懷孕前三個月服用大環(huán)內酯的母親所生的。

"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."

倫敦大學學院大奧蒙德街兒童健康研究所的魯思·吉爾伯特教授說:“我們的發(fā)現(xiàn)表明，如果可以使用替代抗生素，懷孕期間最好避免使用大環(huán)內酯類藥物。”“女性不應該在需要的時候停止服用抗生素，因為未經治療的感染對胎兒的風險更大。”