(Date of issue: July 2016. Version: 1)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Doxycycline (Vibramycin-D®, Efracea®) is an antibiotic that is used to treat a wide range of infections, including in the treatment of acne. Doxycycline may also be used to prevent malaria infection when travelling to certain areas.
Is it safe to take doxycycline in pregnancy?
Doxycycline is not often used during pregnancy, as use during the second or third trimesters is known to cause a baby’s developing milk teeth to be permanently stained and discoloured. Occasionally, however, it may be necessary to use doxycycline to treat an infection during pregnancy (e.g. if no other antibiotic is likely to clear the infection fully) or to use doxycycline to prevent malaria. Prevention of malaria and effective treatment of potentially severe infections during pregnancy are crucial to the health of both mother and baby.
When deciding whether or not to take doxycycline during pregnancy it is important to weigh up how necessary doxycycline is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are. Your doctor is the best person to help you decide what is right for you and your baby.
This leaflet summarises the scientific studies relating to the effects of doxycycline on a baby in the womb.
Can taking doxycycline in pregnancy cause my baby to be born with birth defects?
A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.
Three studies investigating whether women taking doxycycline in early pregnancy were at increased risk of having a baby with a birth defect provided no convincing evidence that this was the case.
A small number of studies have investigated possible links between taking doxycycline in the first trimester and specific birth defects. Because only small numbers of women taking doxycycline have been studied and for some defects the findings were contradictory, more research is needed to confirm these findings. The studies are detailed below:
• Five studies of pregnant women taking doxycycline examined a possible link with cleft lip and/or palate in the baby. While two found evidence of a possible link, the remaining three studies did not agree with this finding. Further research into this subject is therefore required
• None of three studies of a possible link between exposure to doxycycline in early pregnancy and heart defects in the baby provided convincing evidence of a link
• None of three studies of a possible link between exposure to doxycycline in early pregnancy and neural tube defects (such as spina bifida) in the baby provided convincing evidence of a link
What problems can taking doxycycline in the second or third trimesters cause in my baby?
Discolouration of the teeth
It is well known that use of doxycycline during the second or third trimesters of pregnancy can discolour the unborn baby’s developing milk teeth and prevent the enamel from forming properly. This means that when the baby’s milk teeth come through they might be stained grey, brown or yellow. The baby’s second set of permanent teeth will be unaffected.
Effects on bone growth
Doxycycline taken in pregnancy accumulates in the developing baby’s bones and there are concerns that this may affect a baby’s bone growth. Although there are one or two reports of babies exposed to tetracycline (a related antibiotic) in the womb being born with bone problems, it is not clear whether the tetracycline definitely caused them. It has also been shown that tetracycline given to newborn babies temporarily alters their bone growth, but that this returns to normal once the tetracycline is stopped. Until more pregnant women taking doxycycline are studied we cannot say whether doxycycline use during pregnancy is likely to have long-term effects on a baby’s bone growth.
Can taking doxycycline in pregnancy cause miscarriage, stillbirth, preterm birth, or my baby to be small at birth (low birth weight)?
No links between tetracycline use in pregnancy and any of the above pregnancy outcomes are known about, however no scientific studies have been carried out that have specifically investigated this and more research is therefore required.
Can taking doxycycline in pregnancy cause learning or behavioural problems in the child?
A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.
No studies have been carried out to determine whether there is any increased risk of learning and behavioural problems in children who were exposed to doxycycline in the womb and research into this subject is therefore required.
What if I have/am already taking doxycycline during pregnancy?
It is important not to make any changes to your treatment without speaking to your doctor first.
The possible effects on a baby, described above, will depend on how many weeks pregnant you are. If you have taken any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether to continue the medicine(s) that you are on or to change to anther medicine if necessary.
Will my baby need extra monitoring during pregnancy?
As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.
There is no evidence that taking doxycycline during pregnancy causes any problems that would require extra monitoring of your baby.
Are there any risks to my baby if the father has taken doxycycline?
We would not expect any increased risk to your baby if the father took doxycycline before or around the time you became pregnant.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your healthcare provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.