The past two years have not been kind to anyone, but perhaps especially pregnant women. With fears and concerns about the potential risks of contracting Covid during pregnancy, and whether or not pregnant women should get vaccinated (spoiler alert: they should), it’s been a scary time to deliver new babies.
But with so many pregnancy scares orbiting around Covid in recent years, some may have forgotten that not every cough and sniffle is necessarily Covid-related. And the treatment of other diseases also requires extra attention for pregnant women.
Especially when it comes to taking antibiotics to treat these infections.
Pregnancy and antibiotics: are they safe?
Lucky Sekhon, MD, is a Dual Board Certified Fertility Physician and OBGYN. She says antibiotics may be safe when taken during pregnancy, depending on the medication itself. And more importantly, just like the Covid-19 vaccine, the benefits of taking antibiotics during pregnancy often outweigh the potential risks.
“It could be dangerous to under-treat or not medically treat the infection during pregnancy, because then it could turn into a more serious infection,” Sekhon explained.
Of course, knowing which antibiotics to take and when is an important part of the equation. According to the general practitioner Marinea MysoreMD, “It is safe to take certain antibiotics during pregnancy, but there is a list that is safe during pregnancy and this list may change depending on how advanced or what trimester you are in.”
To help track which antibiotics are safe in pregnancy and which are not, the AAmerican College of Clinical Pharmacy (ACCP) follows the Food and Drug Administration (FDA) pregnancy category rankings:
- A: Drugs that have shown no risk to the fetus or pregnant woman in human studies
- B: Drugs that have shown no risk in animal studies, but have not been tested in human studies, and therefore should only be used during pregnancy when clearly indicated
- C: Drugs that have shown adverse effects in animal studies and do not have clear human studies, so these drugs should only be used during pregnancy when there is no best options
- D: Drugs that have shown positive evidence of risk in human trials, risks of which the pregnant patient should be fully aware before taking them (drugs in this category should be avoided during pregnancy if possible)
- X: Drugs contraindicated during pregnancy and which may pose a serious risk of fetal abnormalities
When taking and prescribing antibiotics during pregnancy, it is important to pay attention to these ratings.
All antibiotics pose potential complications, whether a patient is pregnant or not. But some are generally safer than others. Those in categories A and B have the fewest potential complications for a patient and their fetus.
Sekhon said potential complications ultimately depend on the antibiotic itself.
“Some have been shown to cause a higher rate of birth defects and cancers in animal studies, which have not been confirmed in human studies,” she explained. “Other antibiotics, such as streptomycin, are known to pose a risk of hearing loss in babies exposed in utero.”
But there are also antibiotics that fall into these first categories and have very little risk of complications. As well as those that are only considered safe during certain trimesters.
As Mysore explained, “some are safer than others and some antibiotics are safer in one trimester but not another. Examples are penicillin and cephalexin (keflex) which are considered safe in each trimester compared to sulfonamide antibiotics which are generally safe in the second and third trimesters but not in the first trimester.
For all these reasons, it is important for a pregnant person to inform their doctor and pharmacist that they are pregnant before starting any new antibiotic treatment. This way they can discuss potential risks together and choose the safest possible antibiotic to use.
Finding out you are pregnant while taking antibiotics
Of course, pregnancy is not always planned. And there are occasions when a person can find out they are pregnant when they are already taking certain antibiotics.
Then what ?
“I think it depends on what antibiotic they’re taking and why they’re taking it,” Mysore said. “If it’s a safe antibiotic in pregnancy, there’s no harm in taking the course.”
But what if it is a drug that is not considered safe for pregnancy?
“If, for example, you are taking antibiotics for the treatment of acne, this may be a drug you can stop compared to if you are taking an antibiotic for a urinary tract infection or a bacterial sinus infection. “, said Mysore. “Ultimately, I would suggest reaching out to your primary care provider to help you make a decision about what medications you’re taking.”
However, there is no reason to panic. Just pick up the phone and call your doctor as soon as you find out you’re pregnant. From there, you can decide together on the best course of action.
Questions to ask
If you are prescribed antibiotics during your pregnancy, it is perfectly acceptable to ask questions and advocate for yourself and your baby.
“Especially if it’s not your OB’s office that prescribes the medication,” Mysore said.
She recommends asking if the drug is identified as safe for the trimester you’re in. And if it’s a necessary drug and it’s not a category A drug, she said you should also ask what the potential risks might be.
“If your provider isn’t sure, don’t be afraid to take them back to your OB for advice,” she said.
Sekhon agreed, adding, “Category C drugs for pregnancy should be avoided and taken only if necessary and the potential risks are outweighed by the benefits. It is also important to know if there is a better alternative antibiotic you can switch to.
The good news is that often with antibiotics there are alternatives that can be considered.
“Being pregnant doesn’t mean you have to avoid (antibiotic) drugs at all costs,” Sekhon said. “Talk to your doctor about the pros and cons of any medications you are considering taking in early pregnancy.”
And take care of yourself while you’re at it. One way to do this, according to Mysore, is to always take a probiotic while taking antibiotics, whether you’re pregnant or not. This can help prevent some of the potential unpleasant side effects of antibiotics like yeast infections. Something no one wants to deal with, but especially not during pregnancy.