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Prenatal Azithromycin Exposure and Risk of Neurodevelopmental Disorders in Children

Marianne N Otoo1, Kimford J Meador2, Todd Brothers1

  • 1Department of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston.

JAMA Network Open
|May 12, 2026
PubMed

Insights

Prenatal exposure to azithromycin in late pregnancy may lower the risk of neurodevelopmental disorders (NDDs), including speech and language disorders (SLDs). Further research is needed to confirm these findings for azithromycin use during gestation.

Area of Science:

  • Obstetrics and Gynecology
  • Pediatrics
  • Pharmacology

Background:

  • Azithromycin is frequently prescribed during pregnancy for bacterial infections.
  • The impact of prenatal azithromycin exposure on child neurodevelopment remains unclear.

Purpose of the Study:

  • To investigate the association between prenatal azithromycin exposure and the risk of neurodevelopmental disorders (NDDs) in children.
  • To compare risks between azithromycin, other antibiotics, and no antibiotic exposure during pregnancy.

Main Methods:

  • Retrospective cohort study utilizing administrative health claims data.
  • Included mother-infant dyads with live births between December 2012 and December 2023.
  • Propensity score matching was used to compare exposure groups (azithromycin, other antibiotics, no antibiotics).

Main Results:

  • Late pregnancy azithromycin exposure was linked to a reduced risk of speech and language disorders (SLD) compared to no antibiotic exposure.
  • Azithromycin exposure in late pregnancy was also associated with a lower risk of overall NDDs and SLDs compared to exposure to other antibiotics.

Conclusions:

  • Late pregnancy azithromycin exposure may be associated with a decreased risk of NDDs, particularly SLDs.
  • Clinical use of azithromycin in pregnancy should follow established guidelines.
  • Larger, diverse studies are necessary to validate these findings.
Abstract

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