Watch for Antibiotic Overuse Among Pregnant Women

Pharmacists should use caution when providing antibiotics to pregnant women, as prenatal antibiotic use has been linked to subsequent asthma in offspring.

This association particularly holds true for children already at risk for asthma and allergy, according to research published in the Annals of Allergy, Asthma, and Immunology.

In the study, researchers identified 298 mother-child pairs living in disadvantaged areas of urban Chicago who had information concerning systemic antibiotic use and were followed through the child's third year of life in the previous Peer Education in Pregnancy Study.

The investigators looked for asthma diagnosis from a physician by age 3 and reported wheezing in the third year of life. Both were assessed based on the mother’s self-reported answers to the questions, “Has a doctor ever told you that your child has asthma?” and “Has your child's chest sounded wheezy or whistling?”

Of 103 children born to mothers who took antibiotics during their pregnancies, 22% were diagnosed with asthma by age 3, compared with only 11% of the 195 children born to mothers who did not take antibiotics during pregnancy. In terms of the culprit behind this trend, the researchers hypothesized that the modification of microbial load could be occurring prenatally, affecting the maturation of the infant immune system and increasing a child’s risk for developing asthma.

“Pre- and perinatal events are essential in shaping the development of the immune system, and systemic antibiotic use during this time could alter the maternal or placental microbiome, leading to an increase in the child's risk of developing asthma,” the authors wrote.

Wheezing, however, was only weakly linked to the development of asthma in children born to mothers who took prenatal antibiotics, though the study authors noted that a similar trend for wheezing could be defined in a larger cohort study.

The researchers commented that the prevalence of asthma has doubled in developed countries over the past 30 years, with poor and minority children being diagnosed more frequently. They expressed concern about pregnant women taking antibiotics, especially when symptoms are not distinctly caused by a bacterial infection.

Still, the authors advised caution in providing antibiotics pregnant women, rather than discouraging the practice altogether. However, they advised that antibiotics should be avoided unless absolutely necessary.

“It’s important for pharmacists to note and notice if their patients are pregnant, why they are taking antibiotics, and if they are aware of any potential risks. Ideally, pharmacists could track the number of courses of antibiotics used during the pregnancy and be vigilant for overuse,” study author Brittany Lapin, MPH, told Pharmacy Times. “I think it is important for pregnant women to use antibiotics only when necessary and to watch for overuse.”

The International Pharmaceutical Federation (FIP) recently published a report that called for greater pharmacist involvement in antimicrobial stewardship efforts and detailed specific contributions that pharmacists can make.

“Pharmacists can’t just expect others to do it,” said Fred M. Eckel, ScD, Editor-in-Chief of Pharmacy Times. “We must make our own contributions if we want to fix this problem.”