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Trimethoprim is a man-made antibiotic that interferes with the metabolism of folic acid.  It is recommended that all women of childbearing age take 400 micrograms of folic acid a day, because folic acid is used to make the extra blood your body needs during pregnancy and many women do not find out they are pregnant until several weeks after conception.  Folic acid is especially important for pregnant women to take because it reduces your baby's chances of developing serious birth defects.

 

It is difficult to determine the exact teratogenic effects of trimethoprim.  But, while it is unethical to perform experiments concerning the effects of trimethoprim on developing fetuses, many retrospective case studies have been conducted.  In addition, several studies with rats and rabbits are generalized to the possible effects on humans.

 

A lack of folic acid may lead to several birth defects, including Spina Bifida, Anencephaly, cardiovascular defects, Cleft Palate, Polydactyly, limb-reduction defects, Hypospadias, and urinary tract malformations. 

 

• Spina bifida is a condition in which the bottom of the neural tube does not close properly in the first month of pregnancy, leaving the spinal cord exposed.  Some infants born with Spina Bifida have significant damage to the spinal cord and nerves.  The nerve damage is permanent, even though the openings can be fixed via surgery after birth.  Infants with Spina Bifida have varying degrees of nerve damage to the lower limbs, resulting in paralysis.
• Anencephaly occurs when the neural tube does not close to form the brain and spinal cord in the third and fourth week of pregnancy.  The failure of the top of the neural tube to close results in the absence of certain parts of the brain, skull, and scalp.  Babies born with this disorder are often missing their forebrain and cerebellum.  Infants with Anencephaly are either stillborn or do not live long after birth.
• Cleft Palate is an opening in the roof of the mouth, connecting to the nasal cavity, as a result of failure to close during pregnancy.  It may occur in conjunction with a cleft lip.  These conditions can be fixed via surgery one to two years after birth.

• Polydactyly is a birth defect in which the infant has more than five fingers or toes on each hand or foot.
• Hypospadias is a birth defect in which the urethra opens on the underside of the penis, instead of on the tip.  It is usually fixed via surgery with in the first year after birth.

 

Following pregnancy, use of trimethoprim should also be avoided.  Trimethoprim is excreted in human milk and is therefore passed directly to your baby.  Trimethoprim passed to your baby via the placenta or human milk may result in kernicterus, a type of brain damage associated with deafness, problems with vision and teeth, athetoid cerebral palsy, and jaundice.

 

Trimethoprim is a component of many different prescribed drugs used to treat urinary tract infections, traveler's diarrhea, respiratory and middle ear infections.  It can also be combined with sufamethoxaole or dapsone to prevent and treat Pneumocystis infection.  Bactrim, Septra, Trimpex, Proloprim, and SMX-TMP, sometimes called cotrimoxazole, are a few drugs that include trimethoprim.

 

Many studies concur that folic acid inhibitors, including trimethoprim, should only be taken during pregnant if the benefits to the mother outweigh the possible risk to the fetus.

 

 

References:

(2000). Medications That Interfere With Folic Acid Raise Risk of Serious Birth Defects, Study Shows. March of Dimes. September 30, 2007, http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=0&page_id=1878&query=drugs%20interfere%20with%20folic%20acid&hiword=ACIDE%20ACIDO%20ACIDS%20DRUG%20FOLICO%20FOLIK%20INTERFERED%20INTERFERES%20INTERFERING%20INTERFERON%20WITHERS%20WITHIN%20WITHING%20WITHL%20acid%20drugs%20folic%20interfere%20with%20

 

(2006). Folic Acid. American Pregnancy Association. September 30, 2007, http://www.americanpregnancy.org/pregnancyhealth/folicacid.html

(2007). Trimprex: Warnings and Precautions. RXList.  September 30, 2007, http://www.rxlist.com/cgi/generic/trimeth_wcp.htm

 

Briggs, Gerald. (n.d.) Is it safe to take antibiotics during pregnancy? BabyCenter. September 30, 2007,  http://www.babycenter.com/400_is-it-safe-to-take-antibiotics-during-pregnancy_506595_1000.bc?Ad=com.bc.common.AdInfo%407c94753a

Ellison, R. (January 11, 2001). Trimethoprim and Birth Defects.  Journal Watch Infectious Diseases. September 30, 2007,http://infectious-diseases.jwatch.org/cgi/content/full/2001/111/1

Marks, J.W. (2006). Trimethoprim. September 30, 2007, http://www.medicinenet.com/trimethoprim/article.htm

McEwen, L. M. (1971). Trimethoprim/Sulphamethoxazole Mixture in Pregnancy. British Medical Journal, 4(5785). September 30, 2007, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1799666

Trimethoprim: Drugs in Pregnancy and Lactation. September 30, 2007, http://drugsafetysite.com/trimethoprim

 

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