From the Guidelines
Doxycycline is not recommended during pregnancy, including at 17 weeks gestation, due to potential risks to the developing fetus, such as cosmetic staining of primary dentition and effects on musculoskeletal development 1. The use of tetracycline-class drugs, including doxycycline, has been contraindicated during pregnancy because of concerns about potential risks to the fetus, including cosmetic staining of primary dentition in fetuses exposed during the second or third trimester, and development of acute fatty liver of pregnancy in the mother 1. Although some studies suggest that therapeutic doses of doxycycline are unlikely to pose a substantial teratogenic risk, the data are insufficient to conclude that no risk exists, and controlled studies to assess the safety of doxycycline use in pregnant women have not been conducted 1. If an antibiotic is needed during pregnancy, safer alternatives include penicillins (such as amoxicillin), certain cephalosporins, or azithromycin, depending on the specific infection being treated, as these medications have better established safety profiles in pregnancy. It is essential to consult with your obstetrician or healthcare provider before taking any medication during pregnancy, as they can recommend the most appropriate treatment based on your specific situation, weighing the benefits against potential risks. In cases where doxycycline is considered necessary for a life-threatening illness, its use may be indicated, but this should be done under close medical supervision and with careful consideration of the potential risks and benefits 1.
From the FDA Drug Label
Pregnancy: Teratogenic effects. Pregnancy Category D: There are no adequate and well-controlled studies on the use of doxycycline in pregnant women The vast majority of reported experience with doxycycline during human pregnancy is short-term, first trimester exposure. There are no human data available to assess the effects of long-term therapy of doxycycline in pregnant women, such as that proposed for treatment of anthrax exposure An expert review of published data on experiences with doxycycline use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (the quantity and quality of data were assessed as limited to fair), but the data are insufficient to state that there is no risk
The use of doxycycline at 17 weeks pregnant is not recommended due to the lack of adequate and well-controlled studies on its use in pregnant women, especially during the second trimester. The limited data available suggest that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk, but the data are insufficient to state that there is no risk. Therefore, doxycycline should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus 2.
From the Research
Safety of Doxycycline During Pregnancy
The use of doxycycline during pregnancy, particularly at 17 weeks gestation, is a topic of interest due to its classification as a class D drug, which is generally contraindicated in pregnancy. However, recent studies suggest that doxycycline may be safer than previously thought.
Key Findings
- A systematic review of the available literature on doxycycline use in pregnant women and children revealed a safety profile of doxycycline that differed significantly from that of tetracycline, with no correlation between the use of doxycycline and teratogenic effects during pregnancy or dental staining in children 3.
- A descriptive study using the United States Food and Drug Administration Adverse Event Reporting System database found that the number of reported events of adverse pregnancy/neonatal outcomes following doxycycline use is small, and there does not seem to be a strong signal of harm, although this needs to be confirmed by surveillance studies 4.
- A study on the use of doxycycline in combination with anti-malarial drugs for intermittent preventive treatment of Plasmodium falciparum malaria infection in pregnant women in Africa suggested that doxycycline may be a good option to retard the emergence and spread of resistance to artemisinin-based combination therapy (ACT) and improve the effectiveness of ACT in terms of preterm births, neonatal morbidity, and mortality 5.
- However, a review of the available data on the safety of doxycycline for young children or for pregnant or breastfeeding women suggested that doxycycline should continue to be only selectively prescribed for these populations, and courses of treatment should be of as short a duration as possible 6.
- A systematic review of the safety of antimicrobials during pregnancy, including doxycycline, found that doxycycline was associated with cardiovascular malformations and spontaneous abortion in some studies, but the evidence was limited and more data are needed to confirm these associations 7.
Considerations for Use
- The decision to use doxycycline during pregnancy should be made on a case-by-case basis, taking into account the potential benefits and risks.
- The use of doxycycline during pregnancy may be considered for the treatment of certain infections, such as rickettsial diseases or malaria, where the benefits of treatment outweigh the potential risks.
- Pregnant women who require doxycycline treatment should be closely monitored for potential adverse effects, and alternative treatments should be considered whenever possible.