Safety of cotrimoxazole in pregnancy: a systematic review and meta-analysis.
Safety of cotrimoxazole in pregnancy: a systematic review and meta-analysis.
复制标题
DOI：
10.1097/qai.0000000000000211
复制
发表时间：
2014-08-15
期刊：
影响因子：
--
通讯作者：
Mofenson L
中科院分区：
文献类型：
--
作者：
Ford N;Shubber Z;Jao J;Abrams EJ;Frigati L;Mofenson L
Cotrimoxazole is widely prescribed to treat a range of infections and for HIV-infected individuals it is administered as prophylaxis to protect against opportunistic infections. Some reports suggest that fetuses exposed to cotrimoxazole during early pregnancy may have an increased risk of congenital anomalies. We carried out this systematic review in order to update the evidence of cotrimoxazole safety in pregnancy. Three databases and one conference abstract site were searched in duplicate up to 31 October, 2013 for studies reporting adverse maternal and infant outcomes among women receiving cotrimoxazole during pregnancy. This search was updated in MEDLINE via PUBMED to 28 April 2014. Studies were included irrespective of HIV-infection status or the presence of other co-infections. Our primary outcome was birth defects of any kind. Secondary outcomes included spontaneous abortions, terminations of pregnancy, stillbirths, preterm deliveries, and drug-associated toxicity. 24 studies were included for review. There were 232 infants with congenital anomalies among 4196 women receiving cotrimoxazole during pregnancy, giving an overall pooled prevalence of 3.5% (95% CI 1.8–5.1%; τ2 0.03). Three studies reported 31 infants with neural tube defects, giving a crude prevalence of 0.7% (95%CI 0.5–1.0%) with most data (29 neural tube defects) coming from a single study. The majority of adverse drug reactions were mild. The quality of the evidence was very low. The findings of this review support continued recommendations for cotrimoxazole as a priority intervention for HIV-infected pregnant women. It is critical to improve data collection on maternal and infant outcomes.
