{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:00:35Z","timestamp":1785463235002,"version":"3.56.0"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["U24 HD92904"],"award-info":[{"award-number":["U24 HD92904"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The randomized trial of azithromycin to reduce maternal and neonatal sepsis (the A\u2010PLUS Trial) found substantial reduction in maternal sepsis among women receiving azithromycin and substantial non\u2010study antibiotic use. This secondary analysis explored the effect modification of non\u2010study antibiotics on azithromycin versus placebo on maternal and newborn infection among A\u2010PLUS participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women \u226528\u2009weeks gestation in labor and planning a vaginal delivery at a study hospital in seven low\u2010 and middle\u2010income countries (Bangladesh, India [two sites], Pakistan, Guatemala, Kenya, Democratic Republic of Congo, and Zambia) were eligible for inclusion. Non\u2010study antibiotic use was collected prospectively. We estimated the interaction of non\u2010study antibiotics with azithromycin versus placebo on maternal and newborn sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 29\u2009287 participants were randomized (14\u2009590 to azithromycin; 14\u2009688 to placebo). Maternal infection was reduced among the azithromycin group compared to placebo among those who did not receive non\u2010study antibiotics, with estimated relative risk (RR) 0.58 (95% confidence interval [CI] 0.48, 0.70), and among those who received non\u2010study antibiotics, with RR 0.80 (95% CI 0.70, 0.91). Similar results were observed for maternal sepsis. Neonatal infection was not significantly reduced in any group. These results were similar when stratified by African and Asian region but not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results suggest a benefit of azithromycin in reducing maternal infection or sepsis across all groups, with a larger reduction in risk among participants who had not received other antibiotics. Given the concerns of inappropriate use of antibiotics, further research is warranted to determine the most effective strategies of reducing risk of infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70721","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:51:28Z","timestamp":1768215088000},"page":"1362-1371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non\u2010study post\u2010partum antibiotics use and risk of maternal and neonatal infection: A secondary analysis of the A\u2010\n                    <scp>PLUS<\/scp>\n                    randomized controlled trial"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-5444","authenticated-orcid":false,"given":"Elizabeth M.","family":"McClure","sequence":"first","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7244-9056","authenticated-orcid":false,"given":"Alan T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"School of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-9079","authenticated-orcid":false,"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[{"name":"School of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6797-8631","authenticated-orcid":false,"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet L.","family":"Moore","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences RTI International  Durham North Carolina 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