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Maternal use of cystitis medication and childhood epilepsy in a danish population-based cohort

Jessica E Miller1, Lars Henning Pedersen, Yuelian Sun

  • 1Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA. jemille@ucla.edu

Paediatric and Perinatal Epidemiology
|October 16, 2012
PubMed

Insights

Maternal use of cystitis antibiotics like pivmecillinam, sulphamethizole, and nitrofurantoin during pregnancy was linked to a slightly increased risk of childhood epilepsy. This association may stem from maternal infection impacting fetal brain development.

Area of Science:

  • Perinatal epidemiology
  • Neurodevelopmental disorders
  • Pharmacovigilance

Background:

  • Maternal infections during pregnancy are linked to adverse neurological outcomes in offspring, including epilepsy.
  • Urinary tract infections (cystitis) are common in pregnancy and treated with antibiotics.

Purpose of the Study:

  • To investigate the association between maternal use of common cystitis antibiotics during pregnancy and the risk of childhood epilepsy.
  • To determine if specific antibiotics (pivmecillinam, sulphamethizole, nitrofurantoin) are associated with increased epilepsy risk.

Main Methods:

  • Population-based cohort study in Denmark (1996-2004) using national health registers.
  • Inclusion of liveborn singletons with data on epilepsy diagnoses and maternal antibiotic prescriptions.
  • Statistical analysis using Cox proportional hazard regression to estimate Hazard Ratios (HR) and 95% Confidence Intervals (CI).

Main Results:

  • A cohort of 447,629 children followed for up to 9.9 years identified 2,848 epilepsy cases.
  • Slightly increased epilepsy risks observed with maternal use of pivmecillinam (HR=1.2), sulphamethizole (HR=1.2), and nitrofurantoin (HR=1.1).
  • Adjusted HRs for multiple prescriptions were 1.3 for all three antibiotics, suggesting a potential dose-response relationship.

Conclusions:

  • The similar associations across chemically diverse cystitis antibiotics suggest a possible role of maternal infection in fetal brain development.
  • Direct pharmacological effects of the antibiotics or unmeasured confounding factors remain alternative explanations for the observed association.
Abstract

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