This article is more than 5 years old. Information may no longer be current.
Fluconazole use during pregnancy increases risk for spontaneous abortion
Click Here to Manage Email Alerts
Treatment of vaginal candidiasis with fluconazole may be associated with an increased risk for spontaneous abortion among pregnant women, according to the results of a populationwide Danish study.
“Concern regarding the safety of fluconazole use in pregnancy has been raised after case reports have linked long-term, high-dose fluconazole treatment in pregnant women to a distinct pattern of craniofacial and skeletal birth defects,” the researchers wrote. “Only two epidemiologic studies have investigated spontaneous abortion and stillbirth, suggesting that fluconazole is not associated with an increased risk; however, with a combined sample of 1,512 fluconazole-exposed pregnancies, these studies may not have had sufficient power to detect even a moderately increased risk.”
To explore this potential association, researchers analyzed a cohort of 1,405,663 pregnancies obtained from Danish national registries. Pregnancies from 1997 to 2013 were included if gestational age was available, and if there were no conflicts between multiple records. Fluconazole-exposed pregnancies were matched with up to four nonexposed controls based on propensity scores, age and other similarities. These data were used to determine the HR of spontaneous abortion (pregnancy loss from 7-22 weeks of gestation) and stillbirth (pregnancy loss from 23 weeks to birth) in the exposed and unexposed groups.
The researchers identified 3,315 eligible pregnancies exposed to fluconazole from weeks 7 to 22, and 5,382 pregnancies exposed from week 7 to birth. Compared with unexposed controls, mothers exposed to fluconazole were significantly more likely to experience spontaneous abortion (HR = 1.48; 95% CI, 1.23-1.77). Prevalence was increased regardless of dosage, and continued to be significant when comparing fluconazole exposure with topical azole and pivmecillinam. Although stillbirths also were more prevalent among exposed mothers, the relationship was not statistically significant, leading the researchers to suggest further studies are needed to explore this area of prenatal care.
“In this nationwide cohort in Denmark, oral fluconazole use in pregnancy was associated with a significantly increased risk of spontaneous abortion,” they wrote. “Until more data on the association are available, cautious prescribing of oral fluconazole in pregnancy may be advisable. Although the risk of stillbirth was not significantly increased, this outcome should be investigated further.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts