The antibiotic is broad-spectrum, meaning it targets a wide range of bacteria. It's often used to treat acne, respiratory infections and sexually transmitted infections, such as chlamydia and syphilis. Doctors generally avoid prescribing the drug during the second and third trimesters because it belongs to a class of antibiotics that can bind to calcium in developing bones. Animal studies suggest that this may disrupt fetal bone development.
"I would advise physicians to carefully consider the benefit-risk balance when prescribing doxycycline to women who are pregnant or planning a pregnancy," study first author Almut Winterstein, a pharmacist and drug-safety researcher at the University of Florida, told Live Science in an email.
Among women with respiratory infections, those prescribed doxycycline had a 40% to 54% higher risk of pregnancy loss, compared with those prescribed amoxicillin, another broad-spectrum antibiotic in a different class. The exact level of risk varied between the two databases.
Among the patients treated for acne, doxycycline users had a 49% higher risk of pregnancy loss in one database than those given the antibiotic clindamycin. In the second database, though, the difference wasn't statistically significant. Winterstein said that may be because there were fewer patients included in that analysis.
The researchers examined the risk associated with taking various antibiotics in the first 12 weeks of pregnancy. (Image credit: MementoJpeg via Getty Images)
What drives the risk?
It is not yet clear how the drug might contribute to pregnancy loss. Because the study was observational, it cannot prove that the antibiotic itself caused those losses, which included miscarriages and stillbirths. (Miscarriage is pregnancy loss before 20 weeks of pregnancy, whereas stillbirth refers to pregnancy loss after the 20th week.)
The study authors also noted in their report that the drug may have direct effects on the developing embryo. But these explanations remain hypothetical; the researchers have not established that either mechanism occurs in humans.
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In some cases, doxycycline may still be the best option for a severe infection, Winterstein told Live Science, and that infection could itself put a pregnancy at risk. But for less-serious infections, safer alternatives may be available, she said.
This article is for informational purposes only and is not meant to offer medical advice.
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