Associations between use of macrolide antibiotics during pregnancy and adverse child outcomes

used. Health feautures (self rated health, concomittant disease, BMI, physical activity) parental educational status, family income and perception of its adequacy, student’s pocket money and perception of its adequacy and multidimensional deprivation status (with European Child Deprivation Index, UNICEF,2012) were questioned. Univariate analysis followed by linear regression models was conducted. Conclusions: Background: Evidence on adverse effects of maternal macrolide use during pregnancy is inconsistent. We conducted a systematic review and meta-analysis to investigate the association between macrolide use during pregnancy and adverse fetal and child outcomes.


Background:
Evidence on adverse effects of maternal macrolide use during pregnancy is inconsistent. We conducted a systematic review and meta-analysis to investigate the association between macrolide use during pregnancy and adverse fetal and child outcomes.

Methods:
We included observational studies and randomised controlled trials (RCTs) that recorded macrolide use during pregnancy and fetal and child outcomes. We prioritized comparisons of macrolides with alternative antibiotics (mainly penicillins or cephalosporins) for comparability of indication and effect. Random effects meta-analysis was used to derive pooled odds ratios (OR) for each outcome. We described heterogeneity according to comparators (other antibiotics/placebo) and type of macrolide.

Results:
Of 11,186 citations identified, 19 (10 observational, 9 RCTs) studies were included (21 articles including 228,556 participants). Macrolide prescribing during pregnancy was associated with an increased risk of miscarriage (pooled OR 1Á87, 95% CI 1Á74-2Á00; I2 = 0%), cerebral palsy or epilepsy (1Á78, 1Á18-2Á69; one study) and gastrointestinal malformations (1Á56, 1Á05-2Á32; I2 = 0%) compared with alternative antibiotics. We found no evidence of an adverse effect on 12 other malformations, stillbirth, or neonatal death. Results were robust to excluding studies with high risk of bias. Conclusions: Consistent evidence of an increased risk of miscarriage in mothers prescribed macrolides compared with alternative antibiotics warrants avoidance of macrolides during the first trimester. The uncertain increased risks of cerebral palsy and epilepsy following macrolide treatment should be reported in drug safety leaflets where alternative antibiotics are possible. Further research is needed to examine effects of timing of treatment during critical periods in fetal development and a wider range of child outcomes. Key messages: Macrolide prescribing during pregnancy was associated with an increased risk of miscarriage, with an estimated number needed to harm (NNH) of 20. Consistent evidence for increased risks of miscarriage in mothers prescribed macrolides compared with alternative antibiotics warrants avoidance of macrolides during the first trimester.
Oral hygiene among children in Italy

Background:
Dental caries and periodontal disease are amongst the most widespread oral conditions in human population, affecting from about 67.5% to over 80% of school children in some countries which amounts to a great health burden. The importance of monitoring the oral hygiene is due to the importance that an healthy oral cavity has for individual's overall health and well-being. It enables an individual to masticate, speak and socialize without any active discomfort or embarrassment. The aim of our study was to investigate the oral hygiene among children, using the data from the 2016 edition of ''OKkio alla Salute'' national survey. Methods: ''OKkio alla SALUTE'' is a national surveillance system started in 2007 and promoted by the Italian Ministry of Health. The questionnaire was administered to children aged 8-9 years (attending the third grade of primary school) and their parents. Some specific questions focused on the attention given to oral hygiene.

Results:
We asked children if they washed their teeth the evening before the interview (after having dinner): 83.94% of responders said ''Yes''. 97.69% of them declared to wash teeth at least once a day. A parental high education influenced the habit of washing teeth (OR: 1.25 p < 0.01 for mother education; OR: 1.35 p < 0.01 for father education). 89.70% of children has been visited by a dentist, at a mean age of 5.55 (SD 1.43) years. Mothers and fathers with a high education are more likely to bring their children to dentist than those with a lower education (OR: 1.66, P < 0.01; OR: 1.35, p < 0.01 respectively).

Conclusions:
On the basis of these evidences, schools should better promote the oral health of children. Practitioners, school nurses and school health workers should pay a more specific attention to the use of health-promoting approaches for developing oral health promotion interventions in the schools.

Key messages:
A low parental educational level is associated with a poorer oral hygiene. It is evident the necessity of strengthening school-based health promotion programs focused on oral hygiene.