丹麥學(xué)者的一項研究表明，早期妊娠階段女性應(yīng)用克拉霉素可升高其流產(chǎn)風(fēng)險，但未升高后代先天畸形患病率。論文于2013年1月2日在線發(fā)表于《公共科學(xué)圖書館·綜合》（PLoS ONE）。

　　此項研究利用丹麥生殖數(shù)據(jù)庫確認(rèn)所有分娩女性，并利用丹麥醫(yī)院登記系統(tǒng)確認(rèn)伴流產(chǎn)或人工流產(chǎn)記錄的所有女性。處方資料從丹麥處方登記庫中獲取。主要轉(zhuǎn)歸為克拉霉素應(yīng)用者和非應(yīng)用者的流產(chǎn)和后代嚴(yán)重先天畸形例數(shù)。

　　結(jié)果顯示，共有931,504例妊娠女性被納入研究，其中活產(chǎn)、流產(chǎn)和人工流產(chǎn)例數(shù)分別為705,837、77,553和148,114例。在401例于妊娠前三個月接受克拉霉素治療的女性中，40例（10.0%）出現(xiàn)流產(chǎn)；在活產(chǎn)嬰兒中則有9例（3.6%）伴先天畸形。應(yīng)用克拉霉素后流產(chǎn)的危險比（HR）為1.56。應(yīng)用青霉素或紅霉素未升高流產(chǎn)風(fēng)險。應(yīng)用克拉霉素后后代先天畸形患病率未出現(xiàn)升高（OR 1.03）。

　　Clarithromycin in Early Pregnancy and the Risk of Miscarriage and Malformation: A Register Based Nationwide Cohort Study

　　Background

　　The antibiotic clarithromycin has been associated with fetal loss in animals and a study has found a doubling in the frequency of miscarriages among women using clarithromycin in pregnancy. The aim of the study was to investigate whether clarithromycin use in early pregnancy was associated with an increased risk for miscarriages and major malformations.

　　Methods

　　We conducted a nationwide cohort study including all women in Denmark with a known conception between 1997 and 2007. The Fertility Database was used to identify all women giving birth and the National Hospital Register was used to identify all women with a record of miscarriage or induced abortion. Presc**tion data was obtained from the National Presc**tion Register. The primary outcome was the number of miscarriages and offspring with major congenital malformations among users of clarithromycin compared to non-users.

　　Results

　　We identified 931 504 pregnancies (705 837 live births, 77 553 miscarriages, and 148 114 induced abortions). 401 women redeemed a presc**tion of clarithromycin in the first trimester of which 40 (10.0%) experienced a miscarriage and among the live born nine (3.6%) had offspring with malformations. The hazard ratio (HR) of having a miscarriage after exposure to clarithromycin was 1.56 (CI95% 1.14–2.13). There was no increased hazard of having a miscarriage when being exposed to penicillin or erythromycin. There was no increased prevalence (OR=1.03 (CI95% 0.52–2.00)) of having offspring with malformations after exposure to clarithromycin.

　　Conclusions

　　We found an increased hazard of miscarriage but no increased prevalance of having offspring with malformations among women redeeming a presc**tion of clarithromycin in early pregnancy. This is supported by previous studies in animals and humans. However, further research is required to explore the possible effect of treatment indication on the associations found.

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