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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(02): 192-200
DOI: 10.1055/a-1934-1761
GebFra Science
Original Article

Antibiotic Use During Pregnancy and Childbirth: Prospective Observational Study on Prevalence, Indications, and Prescribing Patterns in a German Tertiary Center

Einsatz von Antibiotika während Schwangerschaft und Geburt: Prospektive Beobachtungsstudie zu Prävalenz, Indikationen und Verschreibungsmustern in einem deutschen Perinatalzentrum
Anna-Lara Schilling
1   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
,
Achim Rody
1   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
,
Verena Bossung 
2   Department of Obstetrics, University Hospital of Zürich, Zürich, Switzerland (Ringgold ID: RIN27243)
1   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Abstract

Introduction Antibiotics are powerful drugs to prevent and treat perinatal infections. Overuse of antibiotics leads to antibiotic resistance, has potential side effects and influences the maternal and neonatal microbiome.

Patients and Methods We performed a prospective observational study on the prevalence, indications, and prescribing patterns of antibiotics during pregnancy and childbirth. We included women who had given birth after 23+0 weeks of gestation at a single tertiary center in Germany from January 2020 to March 2021. Descriptive statistics and binomial regression were performed to analyze the factors influencing the prescription of antibiotics.

Results We included 522 postpartum women into our study. 337 (64.6%) were exposed to antibiotics during pregnancy and/or childbirth. 115 women received antibiotics during pregnancy, 291 during birth. Most antibiotics during pregnancy were prescribed for urinary tract infections (UTIs) (56.0%). Most prescriptions were issued by obstetrics and gynecology physicians (65.8%), followed by hospitals (16.7%) and family medicine physicians (8.8%). Most antibiotics during childbirth were given for a cesarean section (64.3%), followed by preterm rupture of membranes (41.2%). 95.3% of women who had a preterm birth were exposed to antibiotics. In logistic regression models, lower gestational age at birth, higher maternal body-mass-index and smoking were independently associated with antibiotic use during pregnancy and childbirth.

Conclusion We found a high rate of antibiotic exposure during pregnancy and childbirth. Our results imply an urgent need for antibiotic stewardship programs in perinatal medicine as well as further research on the effects of perinatal antibiotic exposure on microbiome development and childhood health.

Zusammenfassung

Einleitung Antibiotika sind potente Medikamente, die verschrieben werden, um perinatale Infektionen zu verhindern oder zu behandeln. Der übermäßige Einsatz von Antibiotika führt zur Antibiotikaresistenz, ist potenziell mit Nebenwirkungen behaftet und hat zudem Auswirkungen auf das mütterliche und neonatale Mikrobiom.

Patientinnen und Methoden Wir führten eine prospektive Beobachtungsstudie durch, um die Prävalenz, die Indikationen und die Verschreibungsmuster für Antibiotika während der Schwangerschaft und der Geburt zu untersuchen. Eingeschlossen wurden Frauen, die nach 23+0 Schwangerschaftswochen zwischen Januar 2020 and März 2021 in einem deutschen universitären Perinatalzentrum Level I entbanden. Es wurden eine deskriptive statistische Analyse sowie binomiale Regressionsanalysen durchgeführt, um Faktoren, welche die Verschreibung von Antibiotika beeinflussen, zu identifizieren.

Ergebnisse Insgesamt wurden 522 Frauen nach der Entbindung eingeschlossen. 337 (64,6%) erhielten Antibiotika während der Schwangerschaft und/oder der Geburt. 115 Frauen erhielten Antibiotika während der Schwangerschaft und 291 Frauen erhielten sie während der Geburt. Die meisten Antibiotika wurden während der Schwangerschaft zur Behandlung von Harnwegsinfektionen verschrieben (56,0%). Die meisten Verschreibungen wurden von Frauenärzten ausgestellt (65,8%), gefolgt von Krankenhäusern (16,7%) und Hausärzten (8,8%). Die meisten während der Geburt verabreichten Antibiotika wurden wegen eines Kaiserschnitts (64,3%) verschrieben; an zweiter Stelle war die Verschreibung wegen vorzeitigen Blasensprungs (41,2%). 95,3% der Frauen, die eine Frühgeburt hatten, wurden mit Antibiotika behandelt. In den Regressionsmodellen war ein niedriges Gestationsalter bei der Entbindung, ein hoher mütterlicher Body-Mass-Index und Rauchen unabhängig voneinander mit dem Einsatz von Antibiotika während der Schwangerschaft und der Geburt assoziiert.

Schlussfolgerung Unsere Studie zeigt eine hohe Antibiotikaexposition von Frauen während Schwangerschaft und Geburt. Die Ergebnisse weisen darauf hin, dass ein Antibiotic-Stewardship-Programm in der Perinatalmedizin dringend nötig ist. Weitere Studien zu den Auswirkungen einer perinatalen Antibiotikaexposition auf die frühe Entwicklung des menschlichen Mikrobioms sowie auf die Gesundheit von Kindern werden benötigt.

Schlüsselwörter

Antibiotika - Schwangerschaft - Antibiotic Stewardship - Mikrobiom

Keywords

antibiotics - pregnancy - antibiotic stewardship - microbiome


Publication History

Received: 19 June 2022

Accepted after revision: 28 August 2022

Article published online:
02 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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