Abstract：
BACKGROUND: Antibiotic use during pregnancy is widespread with notable variations across regions.
METHODS: This systematic review and meta-analysis (Prospero protocol CRD42023418979) examines the prevalence and variability of antibiotic use in pregnancy globally and regionally, considering different methodologies and maternal characteristics. We searched Embase, PubMed, and Web of Science for observational studies published in English from the year 2000 and onwards. Random-effect meta-analyses were used to pool the prevalence of antibiotic consumption during pregnancy, presented as percentages with 95% confidence intervals (CI). Joanna Briggs Institute Critical appraisal checklist for prevalence studies was used for bias assessment.
RESULTS: Overall, 116 studies (14 from Africa, 24 from the Americas, six from Eastern Mediterranean, 57 from Europe, four from South-East Asia and 11 from Western Pacific) were included (33,821,194 pregnancies). The majority of studies (84.5%) were appraised with a low risk of bias. The prevalence of antibiotic consumption during pregnancy ranged between 0.04 to 90%, with a pooled estimate of 23.6% (95% CI: 20.1-27.5, I2 =100%). Low-income countries had the highest pooled prevalence (45.3%, 95% CI: 15.4-79.1, I2 =99.6%). Regionally, the Western Pacific had the highest pooled prevalence (34.4%, 95% CI: 13.4-64.1, I2 =100%). The prevalence of antibiotic consumption during pregnancy increased over time in the Americas and Western Pacific. The studies exhibited considerable heterogeneity (I2 >95%), and the trim-and-fill method estimated a potential 10% underestimation of the overall pooled prevalence, suggesting publication bias.
CONCLUSIONS: This meta-analysis suggests that about 1/4 of women worldwide use antibiotics during pregnancy. This study suggests a high prevalence of antibiotic consumption during pregnancy with disparities according to region and level of country income, ethnicity and whether antibiotics were prescribed or self-medicated. There was a variability in reported findings across age categories, potential bias from small sample sizes, and language bias from including only studies published in English.
METHODS: This systematic review and meta-analysis (Prospero protocol CRD42023418979) examines the prevalence and variability of antibiotic use in pregnancy globally and regionally, considering different methodologies and maternal characteristics. We searched Embase, PubMed, and Web of Science for observational studies published in English from the year 2000 and onwards. Random-effect meta-analyses were used to pool the prevalence of antibiotic consumption during pregnancy, presented as percentages with 95% confidence intervals (CI). Joanna Briggs Institute Critical appraisal checklist for prevalence studies was used for bias assessment.
RESULTS: Overall, 116 studies (14 from Africa, 24 from the Americas, six from Eastern Mediterranean, 57 from Europe, four from South-East Asia and 11 from Western Pacific) were included (33,821,194 pregnancies). The majority of studies (84.5%) were appraised with a low risk of bias. The prevalence of antibiotic consumption during pregnancy ranged between 0.04 to 90%, with a pooled estimate of 23.6% (95% CI: 20.1-27.5, I2 =100%). Low-income countries had the highest pooled prevalence (45.3%, 95% CI: 15.4-79.1, I2 =99.6%). Regionally, the Western Pacific had the highest pooled prevalence (34.4%, 95% CI: 13.4-64.1, I2 =100%). The prevalence of antibiotic consumption during pregnancy increased over time in the Americas and Western Pacific. The studies exhibited considerable heterogeneity (I2 >95%), and the trim-and-fill method estimated a potential 10% underestimation of the overall pooled prevalence, suggesting publication bias.
CONCLUSIONS: This meta-analysis suggests that about 1/4 of women worldwide use antibiotics during pregnancy. This study suggests a high prevalence of antibiotic consumption during pregnancy with disparities according to region and level of country income, ethnicity and whether antibiotics were prescribed or self-medicated. There was a variability in reported findings across age categories, potential bias from small sample sizes, and language bias from including only studies published in English.
摘要：
背景：怀孕期间抗生素的使用普遍存在，各地区之间存在显著差异。
方法：本系统综述和荟萃分析（Prospero方案CRD42023418979）研究了全球和地区妊娠期抗生素使用的患病率和变异性，考虑不同的方法和母亲的特点。我们搜查了Embase,PubMed,和WebofScience从2000年开始以英文发表的观察研究。随机效应荟萃分析用于汇集妊娠期抗生素消耗的患病率，以百分比表示，95%置信区间(CI)。JoannaBriggs研究所用于患病率研究的关键评估清单用于偏倚评估。
结果：总体而言，116项研究(14项来自非洲，24来自美洲，六个来自东地中海，57来自欧洲其中4例来自东南亚，11例来自西太平洋）（33,821,194例怀孕）。大多数研究(84.5%)被评估为低偏倚风险。怀孕期间抗生素消费的患病率介于0.04％至90％之间，合并估计值为23.6%（95%CI：20.1-27.5，I2=100%）。低收入国家的合并患病率最高(45.3%，95%CI：15.4-79.1，I2=99.6%）。区域,西太平洋的合并患病率最高(34.4%，95%CI：13.4-64.1，I2=100%）。在美洲和西太平洋，怀孕期间抗生素消费的患病率随着时间的推移而增加。研究显示出相当大的异质性(I2>95%)，修剪填充法估计总体合并患病率可能被低估10%，暗示出版偏见。
结论：这项荟萃分析表明，全世界约有1/4的妇女在怀孕期间使用抗生素。这项研究表明，怀孕期间抗生素消费的患病率很高，根据地区和国家收入水平存在差异。种族以及抗生素是开处方还是自行用药。不同年龄类别的报告发现存在差异，来自小样本量的潜在偏差，和语言偏见，只包括用英语发表的研究。
方法：本系统综述和荟萃分析（Prospero方案CRD42023418979）研究了全球和地区妊娠期抗生素使用的患病率和变异性，考虑不同的方法和母亲的特点。我们搜查了Embase,PubMed,和WebofScience从2000年开始以英文发表的观察研究。随机效应荟萃分析用于汇集妊娠期抗生素消耗的患病率，以百分比表示，95%置信区间(CI)。JoannaBriggs研究所用于患病率研究的关键评估清单用于偏倚评估。
结果：总体而言，116项研究(14项来自非洲，24来自美洲，六个来自东地中海，57来自欧洲其中4例来自东南亚，11例来自西太平洋）（33,821,194例怀孕）。大多数研究(84.5%)被评估为低偏倚风险。怀孕期间抗生素消费的患病率介于0.04％至90％之间，合并估计值为23.6%（95%CI：20.1-27.5，I2=100%）。低收入国家的合并患病率最高(45.3%，95%CI：15.4-79.1，I2=99.6%）。区域,西太平洋的合并患病率最高(34.4%，95%CI：13.4-64.1，I2=100%）。在美洲和西太平洋，怀孕期间抗生素消费的患病率随着时间的推移而增加。研究显示出相当大的异质性(I2>95%)，修剪填充法估计总体合并患病率可能被低估10%，暗示出版偏见。
结论：这项荟萃分析表明，全世界约有1/4的妇女在怀孕期间使用抗生素。这项研究表明，怀孕期间抗生素消费的患病率很高，根据地区和国家收入水平存在差异。种族以及抗生素是开处方还是自行用药。不同年龄类别的报告发现存在差异，来自小样本量的潜在偏差，和语言偏见，只包括用英语发表的研究。
