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USE OF TETRACYCLINES IN PREGNANCY

Date of issue: June 2024, Version: 2.0

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A corresponding patient information leaflet on USE OF TETRACYCLINES IN PREGNANCY is available.

The tetracyclines are a class of broad-spectrum antibiotics which despite widespread bacterial resistance are still useful in the treatment of chlamydia, rickettsia, brucella, Lyme disease, acne, destructive periodontal disease, exacerbations of chronic bronchitis, leptospirosis, and respiratory or genital mycoplasma infections. Available tetracyclines include tetracycline, demeclocycline, doxycycline, lymecycline, minocycline, oxytetracycline and tigecycline. Doxycycline is also used for malaria prophylaxis in chloroquine-resistant areas and in the treatment of anthrax.

Bacterial infection during pregnancy can be hazardous for both the woman and fetus. The appropriate treatment of maternal bacterial infections which arise during pregnancy is therefore essential.

Fetal exposure to tetracyclines in the second and third trimesters is associated with permanent discoloration of primary dentition and use is therefore generally not advised during pregnancy. Tetracyclines also form a stable calcium complex in bone-forming tissues and therefore theoretical concerns exist that use in pregnancy may also impact fetal development. Tetracyclines may exacerbate fatty liver of pregnancy.

Exposure to tetracyclines in early pregnancy has not been convincingly associated with increased risks of malformation or miscarriage. No effect of antenatal doxycycline exposure on fetal birth weight or preterm delivery risk has been identified in two studies using data from the same cohort. A single study has suggested a possible increased risk of acute lymphoblastic leukaemia following in utero exposure to tetracycline antibiotics; however, this finding is likely confounded and has not been confirmed in further studies. As such, it is not possible to conclude that there is a true causal association between in utero tetracycline antibiotic exposure and acute lymphoblastic leukaemia in childhood.

Where possible, antibiotic choice should be informed by culture and sensitivity tests in accordance with local prescribing guidelines; if treatment is required urgently or before test results become available, then tetracyclines may be considered during the first trimester if an antibiotic with a better fetal safety profile is not possible. Any risks to the fetus should be weighed against the potential adverse effects for the woman and fetus from an untreated infection.

Exposure to tetracyclines at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors present in individual cases may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.