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Study suggests antibiotics for all pregnancies UM researchers say average cost of childbirth would be reduced


Many premature births and other costly complications of childbirth might be avoided if all pregnant women were treated with antibiotics for chlamydia, the nation's most common sexually transmitted disease, according to a computerized cost analysis by a team of University of Maryland scientists.

Treating all women as if they were infected could reduce the average cost of childbirth and its complications by $2,700, a savings 10 times greater than if doctors treated only those women who tested positive, the study found.

"It is very dramatic," said Dr. Judith C. Lovchik, director of the University of Maryland Medical Center pediatric infectious disease lab. "We found it hard to believe ourselves. That's why we feel kind of cautious about this," she said.

The UM team made its cost effectiveness study using a computer model that assessed national data on the prevalence of chlamydia and its related complications, the average costs of treating those complications, and the savings possible by avoiding them.

Pregnant women infected by chlamydia are three to eight times as likely to have a premature delivery, depending on their age, studies show. Their babies, infected as they pass through the birth canal, are twice as likely to suffer pneumonia during their first two months of life and 30 times as likely to have eye infections.

These complications are "significant and expensive," said Dr. Lovchik. The average premature baby requires $44,000 in medical care. Hospitalizing a newborn with chlamydial pneumonia costs $8,000.

Chlamydia is the leading cause of pelvic inflammatory disease in women, posing increased risks of sterility, post-partum infections and pregnancies outside the womb, which can be fatal.

Chlamydia symptoms in men and women range from mild genital discharges, to urination difficulties and abdominal pain. About half of those infected show no overt symptoms.

The unpublished findings on treating with antibiotics were presented yesterday in New Orleans at the 1992 General Meeting of the American Society for Microbiology.

It's not certain why giving antibiotics to all pregnant women as if they had chlamydia would result in the dramatic savings shown in the study. One possible explanation, Dr. Lovchik said, is that erythromycin, the antibiotic used against chlamydia, "has benefits over and above eradicating chlamydia." It's effective against gonorrhea and other organisms that may go undetected, she said, "and maybe some bacteria we haven't discovered yet."

Whatever else it cures, the antibiotic is associated with longer pregnancies, less prematurity, higher birth weights and fewer infections among mothers and their babies.

Dr. Lovchik said she expected the team's report would stir controversy among doctors. "It goes against the grain, against their intuition," she said. The prevailing medical wisdom is that "you don't tend to do blanket medications of supposedly well people. Plus, you don't want to give pregnant women any [medication]. But we're saying the cost figures come out this way."

Dr. Richard Schwarz, past president of the American College of Obstetrics and Gynecology, and provost of the State University of New York Downstate Medical Center, called the idea of prescribing antibiotics for all pregnant women "an ultra-radical approach to the problem. . . . We need far more than a mathematical model" before it can be adopted.

Dr. Lovchik agreed that human studies are needed before treatment of all pregnant women with antibiotics can become routine. She and others writing in the medical literature, however, have urged routine screening of pregnant women and treatment of those who test positive for chlamydia. University Hospital began such screenings in 1986.

"I am firmly convinced . . . that there are adverse effects of chlamydia in pregnancy, but . . . there is a slow trickle-down effect between the literature and what happens in doctors' offices," she said.

The American College of Obstetrics and Gynecology, which sets such standards, believes that routine screening for chlamydia is not cost-effective, a spokeswoman said.

Dr. Lovchik said many doctors, too, believe the chances their patients have chlamydia are low,the screening costly, and any complications minor and inexpensive to treat, she said.

In fact, chlamydia infections are more than twice as common as gonorrhea, with infection rates highest among city teens. Studies in Baltimore during the 1980s found 28 percent to 37 percent of pregnant teens tested had chlamydia.

Infection rates among pregnant women in upper socio-economic groups have been reported at about 5 percent, Dr. Lovchik said. Her study predicted that "even if the prevalence is only 2 percent, we would save money by screening all women and treating the positives," she said.

Routine screening is quick and easy, done with a vaginal swab during prenatal exams. The tests cost from $25 to $65 in Maryland, Dr. Lovchik said. Treatment with erythromycin takes a week, costs about $13, and is at least 80 percent effective. Given during the second trimester, it is regarded as safe for pregnant women and their fetuses.

The sexual partners of infected women can be treated with a less expensive drug, doxycycline, which is not safe for pregnant women. That course of treatment costs about $6.

The UM School of Medicine researchers included Dr. Lovchik; Dr. James I. Hudson, a pediatrician and epidemiologist; Dr. J. Richard Hebel, a statistician and epidemiologist; and Dr. Lindsay S. Alger, a perinatalogist.

The Medical Tribune news service contributed to this article.

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