Antibiotic ‘cerebral palsy link’

Antibiotics appeared to treble the risk of cerebral palsy

A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labor.

The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.

This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study’s 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

These findings do not mean that antibiotics are unsafe for use in pregnancy The Royal College of Obstetricians and Gynaecologists

The Oracle study was the largest trial in the world into premature labor and was set up to investigate whether giving antibiotics – which might tackle an underlying symptomless infection – to women with signs of premature labor would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labor

In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labor (before 37 weeks gestation) whose waters had broken. It delayed onset of labor and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied – co-amoxiclav – showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.

To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Pregnant women should not feel concerned about taking antibiotics to treat infections Chief Medical Officer Sir Liam Donaldson

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment – such as difficulty walking or problems with day to day problem solving – and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.

The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment

The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.

Researcher Professor Peter Brocklehurst of Oxford University said: “We have a suspicion that infection is implicated in premature labour.

“Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment.”

Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: “Pregnant women should not feel concerned about taking antibiotics to treat infections.

“It is important to note that these women had no evidence of infection and would not routinely be given antibiotics.”

Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: “These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics.”

Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

A helpline is available for study participants on 0800 085 2411 between 0930 and 1630 BST. NHS Direct has information available for other members of the public.

A spokeswoman from the special care baby charity Bliss said: “This highlights the importance of fully understanding both the immediate and long-term impact of the care and treatment that both mother and baby receive at this crucial time.”

Mums ‘accept natural birth risks’

About a quarter of UK births are carried out by Caesarean section

First-time mothers-to-be will accept greater risks than clinicians for a natural birth, research suggests.

A Sydney, Australia study also found the women prepared to accept higher pain levels, reports the British Journal of Obstetrics and Gynaecology.

Researchers asked 102 pregnant women and 341 midwives, obstetricians and other doctors what complications would make them choose a Caesarean section.

The journal editor said doctors were “biased”, having seen things go wrong.

This indicates that experiencing labour and attempting a normal birth are two very important priorities in women’s decision-making Professor Philip Steer Editor in chief, BJOG

Approximately one in four pregnancies in the UK ends in a Caesarean section, and most are offered in the face of potential complications such as the baby lying in the wrong position for natural birth.

But the Royal Prince Alfred Hospital study suggested that women, given an informed choice, were less likely than the professionals treating them to take a more cautious approach.

A total of 102 women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons were interviewed to find out whether different complications would prompt them to choose a Caesarean.

Researchers asked them about mild complications such as a prolonged birth and superficial tears to severe problems such as anal and urinary incontinence, vaginal prolapse and severe tearing.

In all categories, the pregnant women were far more likely to be prepared to put up with complications in order to have a natural birth than their midwives or doctors.

Priorities

Study author Catherine Turner said: “Our study found that pregnant women were more likely to aim for a vaginal delivery, and they accept a higher threshold of risks from vaginal delivery when compared with clinicians.”

Professor Philip Steer, the journal’s editor in chief, said: “This indicates that experiencing labor and attempting a normal birth are two very important priorities in women’s decision-making.

“It may also indicate that doctors are biased by their inevitable involvement in complex cases, or labours where things have gone wrong.”

Belinda Phipps, chief executive of the National Childbirth Trust, agreed that health professionals could let their own negative experiences influence the recommendations they gave to women.

“If they’ve seen a traumatic birth, or been involved in a tragedy, there is no debriefing for them.

“It can mean they are more judgemental about the risks involved.”

She added: “I recognise that this is very difficult to avoid, but they need to realise that for most women, this is something that they feel it is important to do for themselves.”