There may be cause for concern over a link between oral antifungal drugs and the risk of miscarriage and stillbirth, new research suggests.
Vaginal yeast infections, also known as candidiasis, are common in pregnancy, with about one in ten pregnant women developing the condition. The usual recommended treatment is with topical azole antifungals, but oral fluconazole is often used due to safety concerns in pregnancy.
The link between oral fluconazole in pregnancy and the risk of miscarriage and stillbirth was investigated by a team from Denmark. Ditte Molgaard-Nielsen and colleagues took figures from a nationwide register on 1,405,663 pregnancies from 1997 to 2013.
This included 3,315 women who were prescribed oral fluconazole between seven and 22 weeks’ gestation. The risk of miscarriage was 48% higher for these women.
Among 5,382 women exposed to fluconazole from gestational week seven to birth, the stillbirth rate was 32% higher, but this was not statistically significant. Stillbirth in Denmark is defined as loss of the foetus after 22 weeks’ gestation.
The study was published in the Journal of the American Medical Association.
"In this nationwide cohort study in Denmark, use of oral fluconazole in pregnancy was associated with a statistically significant increased risk of spontaneous abortion compared with risk among unexposed women and women with topical azole exposure in pregnancy," the authors write.
"Until more data on the association are available, cautious prescribing of fluconazole in pregnancy may be advisable. Although the risk of stillbirth was not significantly increased, this outcome should be investigated further."
Molgaard-Nielsen, D. et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. Journal of the American Medical Association 5 January 2016; doi:10.1001/jama.2015.17844 [abstract]
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