TY - JOUR
T1 - Association of antibiotics therapy during pregnancy with spontaneous miscarriage
T2 - a systematic review and meta-analysis
AU - Omranipoor, Ara
AU - Kashanian, Maryam
AU - Dehghani, Mohsen
AU - Sadeghi, Masoumeh
AU - Baradaran, Hamid Reza
N1 - Acknowledgements
The present study was part of a thesis research conducted by Iran University of Medical Sciences (IUMS), Tehran, Iran. Authors would like to thank Dr. Nazemzadeh for improving the use of English in the manuscript and Ms. Roya Vesal Azad as a librarian for her assistance in systematic searching of the databases.
Funding
The authors received no specific funding for this work.
PY - 2020/7/31
Y1 - 2020/7/31
N2 - Purpose: This systematic review and meta-analysis of observational studies were conducted to assess the association between antibiotics use during pregnancy and spontaneous miscarriage. Methods: A systematic search of online databases as well as reference lists of retrieved studies were performed up to September 2018 to identify observational studies that investigated the association between antibiotics use and spontaneous miscarriage. The retrieved studies were assessed for methodological quality. Pooled relative risk (RR) and 95% confidence intervals were calculated using DerSimonian and Laird method. Random-effects meta-analysis was used to account for conceptual heterogeneity. Sensitivity analysis was performed to assess the robustness of pooled estimates using Stata software. Results: Of 1435 retrieved studies, 89 were reviewed in depth and 12 (8 prospective cohort and 4 population-based case–control studies) met the criteria for inclusion in a systematic review with 1,084,792 participants and 7015 cases of spontaneous miscarriage. Finally, 11 studies were included in the meta-analysis (one study was not included in the meta-analysis owing to methodological issues and low-quality score). Overall percentage of miscarriage in women who received antibiotics was 2.6%. After adjusting for important potential confounders, use of macrolides (RR: 1.42; 95% CI 1.04, 1.93), quinolones (RR: 2.48; 95% CI 1.46, 4.20), and tetracyclines (RR: 2.57; 95% CI 1.95, 3.38) during pregnancy were significantly associated with spontaneous miscarriage. In macrolides class, a significant positive association was found between clarithromycin and spontaneous miscarriage (RR: 1.98; 95% CI 1.46, 2.70). Sensitivity analysis demonstrated the consistency of the results, indicating that the meta-analysis model was robust. Conclusion: Findings support a significant positive association between use of macrolides (especially clarithromycin), quinolones, and tetracyclines during pregnancy and spontaneous miscarriage, although it should be interpreted with caution in the context of limitations of the available data. Review registration: International register for systematic reviews; PROSPEROCRD42018093465.
AB - Purpose: This systematic review and meta-analysis of observational studies were conducted to assess the association between antibiotics use during pregnancy and spontaneous miscarriage. Methods: A systematic search of online databases as well as reference lists of retrieved studies were performed up to September 2018 to identify observational studies that investigated the association between antibiotics use and spontaneous miscarriage. The retrieved studies were assessed for methodological quality. Pooled relative risk (RR) and 95% confidence intervals were calculated using DerSimonian and Laird method. Random-effects meta-analysis was used to account for conceptual heterogeneity. Sensitivity analysis was performed to assess the robustness of pooled estimates using Stata software. Results: Of 1435 retrieved studies, 89 were reviewed in depth and 12 (8 prospective cohort and 4 population-based case–control studies) met the criteria for inclusion in a systematic review with 1,084,792 participants and 7015 cases of spontaneous miscarriage. Finally, 11 studies were included in the meta-analysis (one study was not included in the meta-analysis owing to methodological issues and low-quality score). Overall percentage of miscarriage in women who received antibiotics was 2.6%. After adjusting for important potential confounders, use of macrolides (RR: 1.42; 95% CI 1.04, 1.93), quinolones (RR: 2.48; 95% CI 1.46, 4.20), and tetracyclines (RR: 2.57; 95% CI 1.95, 3.38) during pregnancy were significantly associated with spontaneous miscarriage. In macrolides class, a significant positive association was found between clarithromycin and spontaneous miscarriage (RR: 1.98; 95% CI 1.46, 2.70). Sensitivity analysis demonstrated the consistency of the results, indicating that the meta-analysis model was robust. Conclusion: Findings support a significant positive association between use of macrolides (especially clarithromycin), quinolones, and tetracyclines during pregnancy and spontaneous miscarriage, although it should be interpreted with caution in the context of limitations of the available data. Review registration: International register for systematic reviews; PROSPEROCRD42018093465.
KW - Antibiotic
KW - Meta-analysis
KW - Risk factors
KW - Spontaneous miscarriage
KW - CLARITHROMYCIN
KW - MULTICENTER
KW - RISK
KW - 1ST-TRIMESTER EXPOSURE
KW - MACROLIDES
KW - GESTATIONAL EXPOSURE
KW - FETAL LOSS
KW - ERYTHROMYCIN
KW - 1ST TRIMESTER
KW - OUTCOMES
KW - Humans
KW - Pregnancy
KW - Pregnancy Complications, Infectious/drug therapy
KW - Female
KW - Abortion, Spontaneous/chemically induced
KW - Anti-Bacterial Agents/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85084803495&partnerID=8YFLogxK
UR - https://rdcu.be/b5Di8
U2 - 10.1007/s00404-020-05569-4
DO - 10.1007/s00404-020-05569-4
M3 - Review article
C2 - 32409925
AN - SCOPUS:85084803495
VL - 302
SP - 5
EP - 22
JO - Archives of Gynecology and Obstetrics
JF - Archives of Gynecology and Obstetrics
SN - 0932-0067
ER -