{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:07:01Z","timestamp":1787328421720,"version":"build-2736575974"},"reference-count":91,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Azithromycin is commonly used during pregnancy to treat bacterial infections, but its effects on neurodevelopmental disorders (NDDs) remain inconclusive.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the risk of NDDs in children prenatally exposed to azithromycin compared with those exposed to other antibiotics or with no antibiotic exposure during gestation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used data from an administrative health claims database (January 1, 2012, to October 31, 2024). The study evaluated a mother-infant cohort of mothers aged 12 to 55 years with a live birth between December 1, 2012, and December 31, 2023, who filled at least 1 prescription for an antibiotic or were unexposed to antibiotics during pregnancy. Mothers with antibiotic exposure within 90 days before pregnancy were excluded.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Propensity scores were used to match children exposed to azithromycin with those exposed to other antibiotics or no antibiotics during the entire, early, and late pregnancy periods.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Cox proportional hazards regression models were applied to assess the incidence of NDDs, including attention-deficit\/hyperactivity disorder, autism spectrum disorder, speech and language disorder (SLD), developmental coordination disorder, and behavioral disorders, during follow-up, in the azithromycin cohort compared with those exposed to other antibiotic classes or those with no antibiotic exposure.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 15\u202f527 mother-infant dyads (mean [SD] maternal age, 32.4 [4.1] years) included in this study, 742 (4.8%) were exposed to azithromycin, 3079 (19.8%) were exposed to other antibiotics, and 11\u202f706 (75.4%) remained unexposed to antibiotics during pregnancy. After a mean (SD) follow-up of 5.5 (3.0) years, late pregnancy azithromycin exposure was associated with a lower risk of SLD compared with those unexposed (adjusted hazard ratio [AHR], 0.61; 95% CI, 0.39-0.94) as well as a lower risk of overall NDDs (AHR, 0.69; 95% CI, 0.49-0.98) and SLD (AHR, 0.59; 95% CI, 0.39-0.91) compared with those exposed to other antibiotics.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, late pregnancy azithromycin exposure was associated with a lower risk of NDDs, particularly SLDs. However, azithromycin prescribing during pregnancy should remain guided by clinical necessity and existing safety recommendations; further studies using larger and more diverse populations are warranted to confirm these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.12051","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:00:21Z","timestamp":1778598021000},"page":"e2612051","source":"Crossref","is-referenced-by-count":1,"title":["Prenatal Azithromycin Exposure and Risk of Neurodevelopmental Disorders in Children"],"prefix":"10.1001","volume":"9","author":[{"given":"Marianne N.","family":"Otoo","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimford J.","family":"Meador","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Brothers","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lavoie","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole J.","family":"Asal","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice & Clinical Research, College of Pharmacy, University of Rhode Island, Kingston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Quilliam","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice & 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