JAC Advance Access originally published online on September 30, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 837-841
© 2003 The British Society for Antimicrobial Chemotherapy
Adverse pregnancy outcome in users of sulfamethizole during pregnancy: a population-based observational study
1 Department of Clinical Epidemiology, Aarhus and Aalborg University Hospitals, DK-8000 Aarhus C, Denmark; 2 Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, 90110 Thailand; 3 Department of Clinical Microbiology, Aalborg Hospital, DK-9000 Aalborg, Denmark
Received 23 May 2003; returned 8 July 2003; revised 6 August 2003; accepted 7 August 2003
Objective: To estimate the risk of adverse birth and neonatal outcome, and miscarriage in women who used sulfamethizole during pregnancy.
Methods: The association between use of sulfamethizole and adverse birth and neonatal outcome was investigated in a case–control and a cohort study in Denmark. We used data from the Prescription Database, the Birth Registry and the Hospital Discharge Registry in North Jutland County to study any association between sulfamethizole use and first recorded miscarriage. The cohort analysis included 3484 women who received a prescription for sulfamethizole from 30 days before conception to date of delivery, and 60 175 women who did not use a sulphonamide-containing drug during pregnancy or 30 days before conception. The case–control analysis included 3347 women who had a miscarriage, of whom 90 had taken sulfamethizole, and 22 599 primiparous controls who had a live birth.
Results: Among women who received prescriptions for sulfamethizole, adjusted odds ratios and 95% confidence intervals for adverse birth outcome were: malformation 1.17 (0.95–1.43); low birth weight 0.69 (0.49–0.98); pre-term birth 1.12 (0.97–1.30); stillbirth 1.02 (0.61–1.68); neonatal jaundice 1.14 (0.38–3.46); and for receiving a prescription for sulfamethizole within 1 week before miscarriage 1.66 (0.92–2.99).
Conclusions: We found no increased risk of congenital malformation, stillbirth or pre-term birth, and no association between use of sulfamethizole late in pregnancy and risk of neonatal jaundice. There was an increased risk of miscarriage after exposure to sulfamethizole during the week before miscarriage, but further studies are needed to evaluate whether this increased risk is causal.
Keywords: malformation, pre-term delivery, low birth weight, miscarriage
* Correspondence address. Department of Clinical Epidemiology, Aalborg Hospital, Stengade 10, DK-9000 Aalborg, Denmark. Tel: +45-9932-1086; Fax: +45-9932-1088; E-mail: uxmeno{at}aas.nja.dk