Premature Birth Risk May be Less by Using Antibiotics in Early Pregnancy When Certain Vaginal Infections are Found

(HealthDay News) – Most gynecologists and obstetricians would agree that keeping a pregnant woman as free from prescription drugs as possible is a good thing.

Especially in the early stages of pregnancy, professional health experts strive to allow the fetus to develop as naturally as possible, and only under the most necessary of circumstances should medicinal intervention take place.

But there are indeed exceptions, and one of them involves minor vaginal infections, which if left unattended, could cause miscarriage or premature birth.

A British study found that screening women for vaginal infections early in pregnancy and giving antibiotics to those with an infection mild enough to cause no symptoms reduces the likelihood of miscarriage and premature delivery.

The researchers, who published their findings in the journal The Lancet , found that “the type, dose and route of antibiotic used might be important with respect to outcome," the group at St. George's Hospital in London writes.

The scientists screened 6,102 women making their first prenatal hospital visit, at anywhere from 12 to 22 weeks of pregnancy. They picked out 494 women with symptom-free vaginal infections and divided them into two groups. One got twice-daily, 300-milligram oral doses of the antibiotic clindamycin, the other got a placebo, an inactive substance.

A few women dropped out of the study, but the clinical results were clear, the researchers write: "Women receiving clindamycin had significantly fewer miscarriages or preterm deliveries" -- 13 of 244 in the antibiotic group, 38 of 241 in the placebo group.

The benefits were especially great for women with severe infections. The incidence of miscarriage and preterm delivery was 5.4 percent for those who got the antibiotic, 35.7 percent for those who didn't.

It's a result that pushes obstetricians and gynecologists further toward antibiotic treatment when an infection is found, says Dr. Samuel Bender, assistant professor and member of the Maternal Fetal Medicine faculty practice at the New York University School of Medicine in New York City .

"There has been a lot of literature in the last decade or so going backward and forward on it," Bender says. "Some studies show that treatment makes a difference, some show it does not." One factor involved in the mixed results is that different studies have used different antibiotics, different doses and different routes of delivery, oral or vaginal, he says. Two negative studies that got a lot of attention in the field used a different drug, metronidazole, Bender adds.

The Lancet study, he says, "offers a compelling reason to treat patients with antibiotics, even in the absence of symptoms."

In his own practice, Bender says, "When I have a patient with a positive culture, I tend to treat, knowing that I may be doing some good and hoping that I am not doing any harm."

As for screening, says Dr. Sandra A. Carson, a professor of obstetrics and gynecology at the Baylor School of Medicine in Houston, "it's something we do all the time by getting a Pap smear," emphasizing a recommendation by the American College of Obstetrics and Gynecology that "women should have a Pap smear every year." Her assessment is that British study "may mean that patients, even if asymptomatic, need to be treated."

On the Web

More information about vaginal infections is available from the National Institute of Allergy and Infectious Diseases.

SOURCES: Samuel Bender, M.D., Assistant Professor and member of the Maternal Fetal Medicine faculty practice, New York University School of Medicine , New York City; Sandra A. Carson, M.D., professor and chief of Assisted Reproductive Technology, Baylor School of Medicine, Houston; March 22, 2003, The Lancet
Author: Ed Edelson, HealthDay Reporter
Copyright © 2007 ScoutNews, LLC . All rights reserved.