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Pre-Pregnancy Antibiotics Do Not Prevent Preterm Birth, Researchers Say
NEW ORLEANS, FEB. 5, 2004 – A randomized clinical trial has found that antibiotic treatment before pregnancy did not prevent preterm birth among women who had had a previous premature baby.
“Interconceptional Antibiotics to Prevent Spontaneous Preterm Birth (SPTB): A Randomized Trial,” by William Andrews, M.D., Ph.D., and colleagues at the University of Alabama at Birmingham, explored whether antibiotic treatment before pregnancy would prevent preterm birth among women at high risk because of a previous premature birth. Surprisingly, the treated women had a slightly increased rate of preterm birth and low birthweight compared to the control group.
The paper received the 2004 March of Dimes Award for Excellence in Research on Prematurity at the annual meeting of the Society for Maternal-Fetal Medicine here.
Though some studies in the 1990s had found that treating genital tract infections in pregnant women at high risk for premature birth could help reduce their chances of having a preterm baby, subsequent studies did not have the same result. About 240 women who had had a previous preterm birth were enrolled in the randomized trial three months after delivery; of these, 134 conceived a subsequent pregnancy. The non-pregnant women treated with antibiotics did not go on to have a significantly lower rate of spontaneous preterm birth.
“It appears that the antibiotics reduced the number of bacteria in the treated women, but also seem to have enhanced the inflammatory response, which may have contributed to preterm delivery,” said Dr. Andrews, who is a professor of Obstetrics & Gynecology at the University of Alabama at Birmingham.
Dr. Andrews stressed that this study should not scare women or their health care providers away from antibiotic treatment for clear indications, such as a sinus infection or urinary tract infection, before or during pregnancy. “What our study shows is that the ‘shotgun approach' to eliminating bacteria from the genital tract is not the right approach to reducing preterm birth,” he said.
“We've advanced the complexity of our thinking tremendously with this study,” said Jay Iams, M.D., professor in the Division of Maternal Fetal Medicine at The Ohio State University, and president of the Society for Maternal-Fetal Medicine. “We've closed the door on the idea that the previous studies failed to prevent preterm birth because they didn't give antibiotics early enough. Now we know to concentrate further research on learning how infections and the immune response interact in preterm birth. We need to find better markers for preterm birth and also the genes that may be involved in triggering preterm birth. ”
Nancy S. Green, M.D., medical director of the March of Dimes, who presented the award, noted that there have been several recent successes with other promising treatments for preterm birth, including:
- Progesterone: Two clinical trials have found that a derivative of the hormone progesterone substantially reduced the rate of recurrent preterm delivery among women who were at high risk for preterm delivery.
- Treatment of Group B Streptococcus (GBS) infection: Babies born prematurely are at increased risk for GBS infection. New guidelines from the Centers for Disease Control and Prevention advise that all pregnant women should be screened for GBS at 35 to 37 weeks of pregnancy. Penicillin treatment in late pregnancy or during labor can help prevent transmission of GBS to susceptible newborns.
- Cervical sonography: Some studies have shown that this test may help in predicting preterm birth in some women.
For more information on the Society for Maternal Fetal-Medicine, visit the Web site at smfm.org.
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