The patient is nine months pregnant and in good health. With the proper care, she has much to look forward to.
But then, her labor becomes complicated and her doctor prepares to perform an emergency cesarean delivery. Suddenly, she’s facing a life-threatening event. Her odds of contracting a deadly infection are high, putting both herself and her child at risk.
This may sound like a scenario from the distant past. But it actually may be a glimpse of our not-so-distant future.
Cesarean deliveries put women at risk of serious bacterial infections. And the antibiotics that fight those infections and protect the lives of mothers and children are becoming less and less effective. New antibiotics are urgently needed, and drug companies aren’t developing them fast enough. Unless policymakers curb antibiotic misuse and catalyze research and development of new antibiotics, millions of women may not survive childbirth in the coming decades.
Whenever anyone takes an antibiotic, some bacteria survive. Over time, those microbes adapt, learning how to resist treatment. These survivors then multiply into drug-resistant pathogens, or “superbugs.”
Superbugs already kill 700,000 people worldwide each year. The death toll could reach 10 million by 2050 if we don’t take steps to slow antibiotic resistance.
Pregnant women are particularly vulnerable. Women who undergo cesarean deliveries — which account for a third of U.S. births — are 20 times more likely to develop infections than women who deliver vaginally. Infections already cause one in eight pregnancy-related deaths in the United States, according to a new report from the Centers for Disease Control and Prevention.
In other words, scores of pregnant women already die of infections even in a world with effective antibiotics. If antibiotics stopped working, the death toll would soar. Eventually, giving birth — bringing a life into this world — would require mothers to endanger their own lives.
Newborns would die by the thousands, too. Infants have fragile immune systems, making them vulnerable to many infections, including pneumonia and meningitis. In some cases, newborns pick up infections during delivery.
Infections already take the lives of more than 600,000 newborns worldwide each year. Drug-resistant infections, specifically, killed 214,000 infants in 2015. As bacteria grow more resistant to current antibiotics, those numbers also may skyrocket.
As infectious disease and pregnancy experts, we’ve both devoted our careers to keeping mothers and infants safe. So the prospect of millions of women and babies perishing in childbirth each year is, quite simply, horrifying.
Doctors can help prevent this bleak future. Right now, nearly half of Americans misuse antibiotics, either by filling inappropriate prescriptions, cutting treatments short, or using leftover drugs. Antibiotics are available without a prescription in many low and middle-income countries — where, because of a lack of health providers and adequate facilities, patients often have no choice but to rely on the drugs to tackle all ailments. This misuse fuels resistance. Superbugs do not stop at borders or passport control, so we should all be concerned.
Stewardship programs can help curb inappropriate use of antibiotics. These programs, led by doctors in both outpatient and hospital settings, implement clear guidelines on appropriate antibiotic use. Research shows that stewardship programs help slow the pace of drug resistance. Policymakers could boost funding for these programs to ensure they’re implemented in all health care facilities.
But more stewardship programs alone won’t solve the crisis. Scientists also need to develop newer, more powerful treatments. Unfortunately, that’s easier said than done.
Most major drug companies have shut down their antibiotics research departments, as development of new antibiotics isn’t financially viable. Only policymakers can change that reality.
Ideas abound. One effort, the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act, was recently introduced in Congress. It offers a good starting point, as it would alter Medicare’s reimbursement formula to help spur the appropriate use of new antibiotics. That would boost demand for such drugs — and spur pharmaceutical firms to invest in them.
The act is an important first step, but the number of patients who truly need new antibiotics will still be fairly small — likely too small to allow companies to earn back their initial investments. Policymakers must also provide financial incentives to companies to create new superbug therapies. Such rewards would spur a fresh wave of antibiotic innovation.
Pregnancy announcements should inspire joy. But absent new approaches from Washington, they may instead instill fear.
Caline Mattar, MD, is an assistant professor of medicine specializing in infectious diseases in pregnancy. Megan Foeller, MD, is an assistant professor of obstetrics and gynecology specializing in maternal-fetal medicine and infectious diseases. Both teach at Washington University School of Medicine in St. Louis.