Thinkhamrop Jadsada, Hofmeyr G Justus, Adetoro Olalekan, Lumbiganon Pisake, Ota Erika
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Faculty of Medicine, 123 Mittraparb Highway, Khon Kaen, 40002, Thailand.
Cochrane Database Syst Rev. 2015 Jan 26;1:CD002250. doi: 10.1002/14651858.CD002250.pub2.
Several studies have suggested that prophylactic antibiotics given during pregnancy improved maternal and perinatal outcomes, while others have shown no benefit and some have reported adverse effects.
To determine the effect of prophylactic antibiotics on maternal and perinatal outcomes during the second and third trimester of pregnancy for all women or women at risk of preterm delivery.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved articles.
Randomised controlled trials comparing prophylactic antibiotic treatment with placebo or no treatment for women in the second or third trimester of pregnancy before labour.
We assessed trial quality and extracted data.
The review included seven randomised controlled trials. Approximately 2100 women were recruited to detect the effect of prophylactic antibiotic administration on pregnancy outcomes. Primary outcomesAntibiotic prophylaxis did not reduce the risk of preterm prelabour rupture of membranes (risk ratio (RR) 0.31; 95% confidence interval (CI) 0.06 to 1.49 (one trial, 229 women) low quality evidence) or preterm delivery (RR 0.85; 95% CI 0.64 to 1.14 (five trials, 1480 women) low quality evidence). However, preterm delivery was reduced in the subgroup of pregnant women with a previous preterm birth who had bacterial vaginosis (BV) during the current pregnancy (RR 0.64; 95% CI 0.47 to 0.88 (one trial, 258 women), but there was no reduction in the subgroup of pregnant women with previous preterm birth without BV during the pregnancy (RR 1.08; 95% CI 0.66 to 1.77 (two trials, 500 women)). A reduction in the risk of postpartum endometritis (RR 0.55; 95% CI 0.33 to 0.92 (one trial, 196 women)) was observed in high-risk pregnant women (women with a history of preterm birth, low birthweight, stillbirth or early perinatal death) and in all women (RR 0.53; 95% CI 0.35 to 0.82 (three trials, 627 women) moderate quality evidence). There was no difference in low birth weight (RR 0.86; 95% CI 0.53 to 1.39 (four trials; 978 women) or neonatal sepsis (RR 11.31; 95% CI 0.64 to 200.79); and blood culture confirming sepsis was not reported in any of the studies. Secondary outcomesAntibiotic prophylaxis reduced the risk of prelabour rupture of membranes (RR 0.34; 95% CI 0.15 to 0.78 (one trial, 229 women) low quality evidence) and gonococcal infection (RR 0.35; 95% CI 0.13 to 0.94 (one trial, 204 women)). There were no differences observed in other secondary outcomes (congenital abnormality; small-for-gestational age; perinatal mortality), whilst many other secondary outcomes (e.g. intrapartum fever needing treatment with antibiotics) were not reported in included trials.Regarding the route of antibiotic administration, vaginal antibiotic prophylaxis during pregnancy did not prevent infectious pregnancy outcomes. The overall risk of bias was low except that incomplete outcome data produced high risk of bias in some studies. The quality of the evidence using GRADE was assessed as low for preterm prelabour rupture of membranes, low for preterm delivery, moderate for postpartum endometritis, low for prelabour rupture of membranes, and very low for chorioamnionitis. Intrapartum fever needing treatment with antibiotics was not reported in any of the included studies.
AUTHORS' CONCLUSIONS: Antibiotic prophylaxis did not reduce the risk of preterm prelabour rupture of membranes or preterm delivery (apart from in the subgroup of women with a previous preterm birth who had bacterial vaginosis). Antibiotic prophylaxis given during the second or third trimester of pregnancy reduced the risk of postpartum endometritis, preterm rupture of membranes and gonococcal infection when given routinely to all pregnant women. Substantial bias possibly exists in the review's results because of a high rate of loss to follow-up and the small numbers of studies included in each of our analyses. There is also insufficient evidence on possible harmful effects on the baby. Therefore, we conclude that there is not enough evidence to recommend the use of routine antibiotics during pregnancy to prevent infectious adverse effects on pregnancy outcomes.
多项研究表明，孕期使用预防性抗生素可改善孕产妇和围产期结局，而其他研究则未显示出益处，还有一些研究报告了不良反应。
确定预防性抗生素对所有孕妇或有早产风险的孕妇在妊娠中期和晚期的孕产妇和围产期结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2014年7月31日）以及检索到的文章的参考文献列表。
随机对照试验，比较妊娠中期或晚期临产前预防性抗生素治疗与安慰剂或不治疗对孕妇的效果。
我们评估了试验质量并提取了数据。
该综述纳入了7项随机对照试验。招募了约2100名妇女以检测预防性使用抗生素对妊娠结局的影响。主要结局预防性使用抗生素并未降低胎膜早破（风险比（RR）0.31；95%置信区间（CI）0.06至1.49（一项试验，229名妇女），低质量证据）或早产（RR 0.85；95%CI 0.64至1.14（五项试验，1480名妇女），低质量证据）的风险。然而，既往有早产史且本次妊娠有细菌性阴道病（BV）的孕妇亚组中早产风险降低（RR 0.64；95%CI 0.47至0.88（一项试验，258名妇女）），但既往有早产史且本次妊娠无BV的孕妇亚组中早产风险未降低（RR 1.08；95%CI 0.66至1.77（两项试验，500名妇女））。在高危孕妇（有早产、低出生体重、死产或早期围产期死亡史的妇女）和所有妇女中观察到产后子宫内膜炎风险降低（RR 0.55；95%CI 0.33至0.92（一项试验，196名妇女））以及所有妇女中产后子宫内膜炎风险降低（RR 0.53；95%CI 0.35至0.82（三项试验，627名妇女），中等质量证据）。低出生体重（RR 0.86；95%CI 0.53至1.39（四项试验；978名妇女））或新生儿败血症（RR 11.31；95%CI 0.64至200.79）无差异；且任何研究均未报告血培养证实败血症。次要结局预防性使用抗生素降低了胎膜早破（RR 0.34；95%CI 0.15至0.78（一项试验，229名妇女），低质量证据）和淋菌感染（RR 0.35；95%CI 0.13至0.94（一项试验，204名妇女））的风险。在其他次要结局（先天性异常；小于胎龄儿；围产期死亡率）中未观察到差异，而纳入试验中未报告许多其他次要结局（例如需要用抗生素治疗的产时发热）。关于抗生素给药途径，孕期阴道预防性使用抗生素并未预防感染性妊娠结局。除了一些研究中因不完整的结局数据产生高偏倚风险外，总体偏倚风险较低。使用GRADE评估的证据质量对于胎膜早破为低，对于早产为低，对于产后子宫内膜炎为中等，对于胎膜早破为低，对于绒毛膜羊膜炎为极低。纳入研究中均未报告需要用抗生素治疗的产时发热。
预防性使用抗生素并未降低胎膜早破或早产的风险（既往有早产史且有细菌性阴道病的妇女亚组除外）。妊娠中期或晚期常规使用预防性抗生素可降低产后子宫内膜炎、胎膜早破和淋菌感染的风险。由于随访失访率高且我们每项分析纳入的研究数量少，该综述结果可能存在实质性偏倚。关于对婴儿可能的有害影响也没有足够的证据。因此，我们得出结论，没有足够的证据推荐在孕期使用常规抗生素来预防对妊娠结局的感染性不良影响。
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