The early stages of pregnancy are rarely easy. The first trimester often brings more than a few challenges, morning sickness that can last all day, exhaustion, mood swings and more.
Just under 10% of pregnant women also suffer from at least one urinary tract infection during the first twelve weeks of their pregnancy and even more are found to have harmful bacteria in their urine without symptoms. Although we often think of a UTI as a relatively minor complaint, for a pregnant woman and her unborn child they can be rather dangerous.
Numerous research studies published over the course of many years have linked first trimester UTIs and the non-symptom producing “asymptomatic bacteriuria” to low birth weight, premature birth, even fetal death. An untreated UTI can also cause kidney problems that put both mother and baby at risk.
It is for these reasons that pregnant women are tested frequently for UTIs and are usually treated with a course of antibiotics if the bacteria is present, whether the patient is experiencing symptoms or not. However, just what form of antibiotic should be prescribed has been a cause for concern for some time and a new change in the American College of Obstetricians and Gynecologists (ACOG) guidelines on the issue has put the question back into the spotlight again.
In 2011 ACOG recommended that doctors avoid prescribing two common forms of antibiotic, sulfonamides and nitrofurantoin, unless there was no other alternative available (in case of an allergy for example)
The drug trimethoprim-sulfamethoxazole, prescribed in brand form as Bactrim is a sulfonamide and Macrobid is nitrofurantoin and a new CDC study has found that both antibiotic drugs are still commonly prescribed in the US, even though they have been linked to heart defects, cleft palette and brain malformation in infants.
In fact, they are so commonly prescribed that ACOG changed its recommendations in 2017 to state that these may be used ‘if no alternative antibiotic is available’. According to the CDC report about 70% of the 500,000 women they studied received antibiotics during the first trimester of pregnancy and a significant number were given the drugs that seem to carry potentially higher risks than others.
The concern for many is however, that thanks to a lack of continuing education in pharmaceuticals – few doctors have the time to read every bulletin and research paper released on various medications – or to insurance coverage limitations, women are being prescribed the ‘riskier’ drugs without the potentially safer alternatives ever even being considered, as the new ACOG guidelines suggest.
What can a woman herself do to protect both her child and herself? “Ask questions,” says Darren Miller, attorney with D. Miller and Associates, who specialize in defective drug law and medical malpractice. “Before accepting a prescription ask the doctor is it is the safest medication available and about any possible side effects. Opening up this conversation may prompt a physician to research an issue that they might not have before, helping both the patient reduce risk and remain healthier and increasing the prescriber’s knowledge on the issue. And regardless, it’s good to be well-informed about the possible side effects before taking the medication – that way you’re better equipped to identify side effects if they happen to you.”