***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Intermittent preventive treatment in pregnancy has not been evaluated outside of Africa . Low birthweight ( LBW , < 2,500 g ) is common in Papua New Guinea ( PNG ) and contributing factors include malaria and reproductive tract infections . Methods From November 2009 to February 2013 , we conducted a parallel group , r and omised controlled trial in pregnant women ( ≤26 gestational weeks ) in PNG .  Sulphadoxine-pyrimethamine ( 1,500/75 mg ) plus azithromycin ( 1 g twice daily for 2 days ) ( SPAZ ) monthly from second trimester ( intervention ) was compared against sulphadoxine-pyrimethamine and chloroquine ( 450 to 600 mg , daily for three days ) ( SPCQ ) given once , followed by SPCQ placebo ( control ) . Women were assigned to treatment ( 1:1 ) using a r and omisation sequence with block sizes of 32 . Participants were blinded to assignments . The primary outcome was LBW . Analysis was by intention-to-treat . Results Of 2,793 women r and omised , 2,021 ( 72.4 % ) were included in the primary outcome analysis ( SPCQ : 1,008 ; SPAZ : 1,013 ) . The prevalence of LBW was 15.1 % ( 305/2,021 ) . SPAZ  reduced LBW ( risk ratio [ RR ] : 0.74 , 95 % CI : 0.60–0.91 , P = 0.005 ; absolute risk reduction ( ARR ) : 4.5 % , 95 % CI : 1.4–7.6 ; number needed to treat : 22 ) , and preterm delivery ( 0.62 , 95 % CI : 0.43–0.89 , P = 0.010 ) , and increased mean birthweight ( 41.9 g , 95 % CI : 0.2–83.6 , P = 0.049 ) . SPAZ  reduced maternal parasitaemia ( RR : 0.57 , 95 % CI : 0.35–0.95 , P = 0.029 ) and active placental malaria ( 0.68 , 95 % CI : 0.47–0.98 , P = 0.037 ) , and reduced carriage of gonorrhoea ( 0.66 , 95 % CI : 0.44–0.99 , P = 0.041 ) at second visit . There were no treatment-related serious adverse events ( SAEs ) , and the number of SAEs ( intervention 13.1 % [ 181/1,378 ] , control 12.7 % [ 174/1,374 ] , P = 0.712 ) and AEs ( intervention 10.5 % [ 144/1,378 ] , control 10.8 % [ 149/1,374 ] , P = 0.737 ) was similar . A major limitation of the study was the high loss to follow-up for birthweight . Conclusions SPAZ was efficacious and safe in reducing LBW , possibly acting through multiple mechanisms including the effect on malaria and on sexually transmitted infections . The efficacy of SPAZ in the presence of resistant parasites and the contribution of AZ to bacterial antibiotic resistance require further study . The ability of SPAZ to improve pregnancy outcomes warrants further evaluation . Trial registration Clinical Trials.gov NCT01136850 ( 06 April 2010 ) Because sub clinical genital tract infection may play a major role in preterm birth , the efficacy of adjunctive antibiotic therapy in combination with st and ard parenteral tocolysis was examined in a r and omized , blinded study of patients with idiopathic preterm labor . Labor was documented by three contractions in 20 minutes , cervical dilation of 1 cm or more , and the need for parenteral tocolysis . Enrollment was restricted to patients with intact membranes and without known causes for preterm labor . One hundred three patients at 24–34 weeks ' gestation were r and omized to intravenous ampicillin plus oral erythromycin or corresponding placebos . Compared with the placebo group , the adjunctive antibiotic group had a similar frequency of preterm birth ( 38 versus 44 % ) , time to delivery ( 34 versus 34 days ) , birth weight ( 2847 versus 2855 g ) , and episodes of recurrent labor requiring parenteral tocolysis ( 0.43 versus 0.49 ) . In our population , we found no benefit to the adjunctive use of ampicillin plus erythromycin . Significant differences in genital microflora between our patients and those of other studies may explain our results Low birth-weight is a leading health problem in developing countries . In a r and omized controlled trial , the effect of antimicrobials in pregnant women on improving birth-weight and duration of gestation was evaluated . Two hundred twenty-four pregnant women in their second trimester were r and omized to receive metronidazole ( 200 mg 3 times daily for 7 days ) and cephalexin ( 500 mg twice daily for 5 days ) orally by one group . The mean ( + /-SD ) birth-weights were 2,545 g ( + /-374 ) and 2584 g ( + /-358 , p=0.51 ) , the low birth-weight rates ( < 2.5 kg ) were 40 % and 36 % ( p = 0.28 ) , and the prematurity rates were 8 % and 11 % ( p = 0.6 ) in the treated group and the control group respectively . Due to small sample size , it is cautiously concluded that routine antimicrobials for genital and urinary tract infections of pregnant women do not improve birth-weight or duration of gestation . Rather an unexpected observation was the proportion requiring caesarian section or forceps , which was five-fold higher in the treated group ( p = 0.001 ) , and given no plausible explanations , this finding needs confirmation . Stunted mothers ( < 25th centile or 146.4 cm ) had two-fold higher risk for low birth-weight ( p = 0.04 ) and assisted delivery ( p = 0.1 ) . Low maternal body mass index ( < 25th centile or 18 ) had six-fold higher risk for stillbirth or abortion ( p = 0.007 ) , and high body mass index ( > 75th centile or 21.2 ) had three-fold higher risk for assisted delivery ( p = 0.003 ) OBJECTIVE The purpose of this study was to assess the association of presumptive Trichomonas vaginalis treatment during pregnancy and birth outcomes . STUDY DESIGN A community-r and omized trial of presumptive sexually transmitted disease treatment during pregnancy was conducted between 1994 and 1999 in Rakai district , Ug and a. A sub analysis of a trial of presumptive therapy with azithromycin , cefixime , and metronidazole assessed Trichomonas vaginalis treatment in pregnant women . RESULTS Children of 94 women with Trichomonas who were treated had increased low birth weight ( relative risk , 2.49 ; 95 % CI , 1.12 - 5.50 ) , preterm birth rate ( relative risk , 1.28 ; 95 % CI , 0.81 - 2.02 ) , and 2-year mortality rate ( relative risk , 1.58 ; 95 % CI , 0.99 - 2.52 ) , compared with children of 112 women with Trichomonas who were not treated . CONCLUSION Treatment of Trichomonas vaginalis during pregnancy may be deleterious , and we infer that this may be due to metronidazole . This is consistent with a National Institute for Child Health and Human Development trial that found an excess of preterm births in children of women with Trichomonas vaginalis infection who were treated with metronidazole BACKGROUND Pregnant women with bacterial vaginosis may be at increased risk for preterm delivery . We investigated whether treatment with metronidazole and erythromycin during the second trimester would lower the incidence of delivery before 37 weeks ' gestation . METHODS In 624 pregnant women at risk for delivering prematurely , vaginal and cervical cultures and other laboratory tests for bacterial vaginosis were performed at a mean of 22.9 weeks ' gestation . We then performed a 2:1 double-blind r and omization to treatment with metronidazole and erythromycin  ( 433 women ) or placebo  ( 191 women ) . After treatment , the vaginal and cervical tests were repeated and a second course of treatment was given to women who had bacterial vaginosis at that time ( a mean of 27.6 weeks ' gestation ) . RESULTS A total of 178 women ( 29 percent ) delivered infants at less than 37 weeks ' gestation . Eight women were lost to follow-up . In the remaining population , 110 of the 426 women assigned to metronidazole and erythromycin ( 26 percent ) delivered prematurely , as compared with 68 of the 190 assigned to placebo ( 36 percent , P = 0.01 ) . However , the association between the study treatment and lower rates of prematurity was observed only among the 258 women who had bacterial vaginosis ( rate of preterm delivery , 31 percent with treatment vs. 49 percent with placebo ; P = 0.006 ) . Of the 358 women who did not have bacterial vaginosis when initially examined , 22 percent of those assigned to metronidazole and erythromycin and 25 percent of those assigned to placebo delivered prematurely ( P = 0.55 ) . The lower rate of preterm delivery among the women with bacterial vaginosis who were assigned to the study treatment was observed both in women at risk because of previous preterm delivery ( preterm delivery in the treatment group , 39 percent ; and in the placebo group , 57 percent ; P = 0.02 ) and in women who weighed less than 50 kg before pregnancy ( preterm delivery in the treatment group , 14 percent ; and in the placebo group , 33 percent ; P = 0.04 ) . CONCLUSIONS Treatment with metronidazole and erythromycin reduced rates of premature delivery in women with bacterial vaginosis and an increased risk for preterm delivery OBJECTIVE The purpose of this study was to determine the impact of persistent bacterial vaginosis ( BV ) on the occurrence of spontaneous preterm birth ( SPB ) in women who test positive for fetal fibronectin . STUDY DESIGN This is a secondary analysis of a subset of pregnant women who tested positive for BV and fetal fibronectin between 16(0/7 ) and 25(6/7 ) weeks of gestation and who participated in r and omized placebo controlled trials of antibiotic therapy .  Nugent 's criteria were used for the diagnosis of BV . Patients were reassessed for the presence of BV after treatment . The rate of SPB at < 34 weeks of gestation was analyzed on the basis of treatment mode and BV status at the follow-up visit . RESULTS The primary studies included a total of 3285 women . A subset of 215 women met the criteria for this analysis . Seventy-seven of 100 patients ( 77 % ) in the antibiotics group vs 33 of the 115 patients ( 28.7 % ) in the placebo group became BV negative ( P < .0001 ) . The rate of SPB at < 34 weeks of gestation was lower for BV resolution compared with persistent BV ( 0 vs 5.7 % , respectively ; P = .01 ) . CONCLUSION In women who tested positive for fetal fibronectin and BV , resolution of BV is associated with less SPB before 34 weeks of gestation BACKGROUND The ORACLE II trial compared the use of erythromycin and /or amoxicillin-clavulanate ( co-amoxiclav ) with that of placebo for women in spontaneous preterm labour and intact membranes , without overt signs of clinical infection , by use of a factorial r and omised design . The aim of the present study --the ORACLE Children Study II -- was to determine the long-term effects on children after exposure to antibiotics in this clinical situation . METHODS We assessed children at age 7 years born to the 4221 women who had completed the ORACLE II study and who were eligible for follow-up with a structured parental question naire to assess the child 's health status . Functional impairment was defined as the presence of any level of functional impairment ( severe , moderate , or mild ) derived from the mark III Multi-Attribute Health Status classification system . Educational outcomes were assessed with national curriculum test results for children resident in Engl and . FINDINGS Outcome was determined for 3196 ( 71 % ) eligible children . Overall , a greater proportion of children whose mothers had been prescribed erythromycin , with or without co-amoxiclav , had any functional impairment than did those whose mothers had received no erythromycin ( 658 [ 42.3 % ] of 1554 children vs 574 [ 38.3 % ] of 1498 ; odds ratio 1.18 , 95 % CI 1.02 - 1.37 ) . Co-amoxiclav ( with or without erythromycin 
    Output:
    
Regarding the route of antibiotic administration , vaginal antibiotic prophylaxis during pregnancy did not prevent infectious pregnancy outcomes .
Antibiotic prophylaxis did not reduce the risk of preterm prelabour rupture of membranes or preterm delivery ( apart from in the subgroup of women with a previous preterm birth who had bacterial vaginosis ) .
Antibiotic prophylaxis given during the second or third trimester of pregnancy reduced the risk of postpartum endometritis , term pregnancy with pre-labour rupture of membranes and gonococcal infection when given routinely to all pregnant women .
Therefore , we conclude that there is not enough evidence to support the use of routine antibiotics during pregnancy to prevent infectious adverse effects on pregnancy outcomes