Pregnancy and Antibiotic Resistance: The Perfect Storm

The phenomenon where a bacterial illness cannot be cured by a certain antibiotic, all because the patient’s bacteria no longer respond to it, is called “Antibiotic Resistance.” In women, antibiotic resistance is a crisis waiting to happen, and particularly for pregnant women, the implications are serious.

There is some debate as to how antibiotic resistance can occur. Until very recently, it was believed that not completing the full course of antibiotic medicines, and we’re all guilty of doing this, has led to bacteria adapting and becoming tolerant to those antibiotics. Rampant use of antibiotics in livestock and fish farming is partly responsible for the evolution of the superbug.

However, more recently, a new theory is on the rise— that stopping antibiotic drugs mid-course and giving our body a chance to fight the residual infection can actually prevent the development of antibiotic resistance in bacteria.

While we mull over this chicken-and-egg situation, the threat of antimicrobial resistance looms larger.

Why are women so vulnerable to antibiotic resistance?

As women, due to the way our bodies are built, we have a greater chance of catching infections of the urinary tract (UTIs) and reproductive organs. This means that our earliest introduction to antibiotics probably happened when we are little girls, and continued through life for a variety of infections. Also, our medical system works in a fragmented manner: our ENT wouldn’t know about our Ob/Gyn’s prescription just a few months prior— unless we mention it. So, we run ourselves through quite a few courses of antibiotics in a year, rendering us resistant to some of them.

Antibiotic resistance is a special cause for concern during pregnancy and delivery:

  • A C-Section is a major abdominal surgery, and the risk of sepsis is quite high.[1] If the patient is resistant to a major class of antibiotics, treating sepsis can be very difficult.
  • Surgeries such as repairing a perineal tear after childbirth require the use of antibiotics. If the infection is not prevented using standard antibiotics, a stronger class may not be optimal for breastfeeding.
  • In women whose reproductive tract infections are resistant to antibiotics, the risk of an ectopic pregnancy is very high.[2]
  • Antibiotic resistance is not hereditary: it cannot be passed on to an unborn child. However, the inability to treat an infection in a pregnant woman can lead to preterm birth or stillbirth.

It is imperative to know if you are resistant to antibiotics. Discuss a plan with your doctor for emergencies.

  • Several women use over-the-counter (OTC) products to treat candidiasis. Fungi such as albicans have begun showing resistance to clotrimazole, which is a major component in OTC products. [3] If you have a persistent infection, be sure to see a doctor about it as well as mention all OTC products you have tried.
  • It is advised that you get a disease screening done before you become pregnant.
  • Learn about preventing infection during pregnancy and childbirth.
  • Practice safe sex to avoid the risk of contracting gonorrhoea, a notoriously resistant STD. [4]
  • Most importantly, until established otherwise, be sure to complete your course of antibiotics.

 

References:

  1. Sepsis and Pregnancy. Sepsis Alliance
  2. Burden of Antibiotic Resistance on Women’s Health, ReAct Factsheet
  3. Pelletier, René, Joanne Peter, Cynthia Antin, Corina Gonzalez, Lauren Wood, and Thomas J. Walsh. “Emergence of resistance of Candida albicans to clotrimazole in human immunodeficiency virus-infected children: in vitro and clinical correlations.” Journal of clinical microbiology 38, no. 4 (2000): 1563-1568.
  4. WHO: Antibiotic-resistant gonorrhoea is on the rise.
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