Nakitanda Aya Olivia, Pazzagli Laura, Pasternak Björn, Odsbu Ingvild
Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T4, Astrid Cleves gata 30A, Stockholm, 17176, Sweden.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2025 Jun 19;25(1):672. doi: 10.1186/s12884-025-07736-4.
Understanding determinants of antibiotic use during pregnancy is crucial for optimizing their utilization in clinical practice. We aimed to investigate which individual-level factors are associated with antibiotic use among pregnant women.
Population-based cohort study using linked data from the Swedish national health and population registers spanning from 2006 to 2019. Sociodemographic characteristics, medical and obstetric history, lifestyle and healthcare utilization were investigated as independent variables. Any systemic antibiotic use during pregnancy, the primary outcome, was determined from filled prescriptions, with broad-spectrum antibiotics and multiple courses of antibiotics as secondary outcomes. Multiple logistic regression was used to estimate odds ratios (ORs), including all independent variables in the model.
Among 20 variables associated with any systemic antibiotic use during pregnancy, preconception prescription drug use (OR 1.93 [95% CI 1.87-1.98] for > 4 vs. 0-1 unique therapeutic subgroups), chronic renal disease (1.82 [1.73-1.93]) and low maternal age (1.67 [1.61-1.74] for ages < 20 vs. 30-34 years) had the highest odds. Chronic renal disease, immunodeficiency disorders and preconception drug use (> 4 vs. 0-1 therapeutic subgroups) had the highest odds of broad-spectrum antibiotic use and use of multiple antibiotic courses.
Pre-existing morbidities and low maternal age were most strongly associated with antibiotic use during pregnancy, suggesting a needs-based approach in prescribing. Proactive management of morbidities and infection prevention strategies, particularly targeting young women of reproductive age, could potentially reduce the need for antibiotic treatment in prenatal care.
了解孕期抗生素使用的决定因素对于优化其在临床实践中的应用至关重要。我们旨在调查哪些个体层面的因素与孕妇使用抗生素有关。
基于人群的队列研究，使用了2006年至2019年瑞典国家健康和人口登记处的关联数据。社会人口学特征、病史和产科病史、生活方式和医疗保健利用情况作为自变量进行调查。孕期任何全身性抗生素的使用作为主要结局，通过填写的处方确定，广谱抗生素和多疗程抗生素作为次要结局。使用多元逻辑回归估计比值比（OR），模型中纳入所有自变量。
在与孕期任何全身性抗生素使用相关的20个变量中，孕前使用处方药（使用>4个与0-1个独特治疗亚组相比，OR为1.93[95%CI 1.87-1.98]）、慢性肾病（1.82[1.73-1.93]）和低产妇年龄（年龄<20岁与30-34岁相比，1.67[1.61-1.74]）的比值最高。慢性肾病、免疫缺陷疾病和孕前药物使用（>4个与0-1个治疗亚组相比）使用广谱抗生素和多疗程抗生素的几率最高。
既往疾病和低产妇年龄与孕期抗生素使用的关联最为密切，这表明在开处方时应采取基于需求的方法。对疾病进行积极管理和采取感染预防策略，特别是针对育龄年轻女性，可能会减少产前护理中抗生素治疗的需求。
