Pregnant women need to use antibiotics when they have infectious diseases. Currently, it is known that most antibiotics have adverse effects on the embryo and fetus during pregnancy. Therefore, when choosing antibiotics, their effects on both should be considered. The use of antibiotics in pregnant women generally falls into the following categories: permissible, which have no or minimal harm to the fetus; cautious, which have some harm to the fetus but can be used in short courses and low doses when necessary; and prohibited, which cause severe harm to the fetus and should never be used. The commonly used antibiotics are described below:
Antibiotics that can be used throughout the entire pregnancy include penicillins, cephalosporins, erythromycin, and clindamycin. These four classes of antibiotics are generally not associated with adverse reactions in the fetus when used during pregnancy. Penicillin allergy testing should be conducted before using penicillin drugs to avoid allergic reactions.
Antibiotics that should be used with caution throughout the entire pregnancy include aminoglycosides such as streptomycin, kanamycin, gentamicin, and amikacin. These antibiotics can impair fetal kidney function and hearing, so they should be used with caution. If necessary, they should be used in low doses and for short durations.
Antibiotics that are prohibited during certain stages of pregnancy include chloramphenicol, ethionamide, rifampicin, sulfonamides, and furazolidone within the first 12 weeks of pregnancy, as well as chloramphenicol, ethionamide, sulfonamides, and nitrofurantoin after 28 weeks of pregnancy. Chloramphenicol, rifampicin, ethionamide can cause urinary and auditory malformations, deafness, limb malformations, hydrocephalus, stillbirth, and neonatal death. Sulfonamides can cause neonatal jaundice and hemolytic anemia, while nitrofurantoin can cause neonatal hemolysis.
Antibiotics that are prohibited throughout the entire pregnancy include 1. polymyxins, colistin, which have toxic effects on the kidneys and nervous system and can affect the fetus through the placenta. 2. Tetracyclines are typical teratogenic drugs. In early pregnancy, they chelate with calcium salts and prevent the entry of calcium salts into cartilage and bones, leading to poor limb development and limb malformations in the fetus. In mid-pregnancy, they inhibit fetal bone growth, resulting in congenital cataracts and abnormal development of deciduous teeth, which appear yellow. In late pregnancy, they cause yellow deposits in deciduous teeth and bones due to tetracycline deposition and can also cause maternal hepatic steatosis. Therefore, tetracyclines are prohibited for pregnant women. 3. Metronidazole (also known as flagyl) is teratogenic and should be avoided by pregnant women. 4. Amphotericin B, griseofulvin, and others have significant toxicity to the nervous system, blood, liver, and kidneys. Griseofulvin is teratogenic and may also cause miscarriage.
