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A retrospective, active-comparator cohort study found that doxycycline use for respiratory tract infections or acne during early pregnancy was associated with an increased risk for pregnancy loss. Given the frequent use of doxycycline by women of childbearing age, these findings underscore the importance of both clinicians and patients weighing the benefits and risks when considering treatment with doxycycline. The findings are published in Annals of Internal Medicine.

Doxycycline is a commonly used antibiotic that is prescribed to treat a variety of infections, including skin and respiratory tract infections. Researchers from the University of Florida and colleagues analyzed insurance claims data from commercial and Medicaid databases of 218,234 pregnancies from women with respiratory tract infections and 6,636 pregnancies from women with acne to assess whether taking doxycycline during early pregnancy was associated with pregnancy loss.

They compared women who filled prescriptions for doxycycline during the first trimester with similar women who received alternative treatments, including amoxicillin and macrolides for respiratory tract infections and topical clindamycin for acne.

In both insurance claims databases, there was a higher risk for pregnancy loss among women with respiratory tract infections who used doxycycline.

In patients with acne, risk was higher in pregnancies with doxycycline exposure in the commercial claims database, but not in Medicaid. The findings provide additional data to inform clinical recommendations for the treatment and postexposure prophylaxis of infections during pregnancy.

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