Oral antifungal linked to higher rates of miscarriage

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The oral antifungal drug fluconazole, which is used to treat vaginal yeast infections, has been linked to higher rates of miscarriage if used during pregnancy, according to research published in the Canadian Medical Association Journal.

Although topical treatments are the first-line treatment for fungal infections in pregnant women, oral fluconazole is also sometimes used.

In this study the researchers assessed data from the Quebec Pregnancy Cohort – totalling 441,949 pregnancies from between 1998 and 2015 – and linked this with filled prescriptions from the Quebec Prescription Drug Insurance database.

The team discovered that most women exposed to fluconazole in pregnancy received a single therapeutic dose of 150mg (69.5%), the remainder received a higher dose, above 150mg. Use of oral fluconazole during early pregnancy was observed to be associated with an increased risk of spontaneous abortion compared with no exposure, in addition, exposure to high-dose fluconazole during the first trimester was linked with an increased risk of cardiac septal closure abnormalities.

These results are consistent with other studies; however, the researchers caution that more work is needed with larger samples.

In a related commentary, Vanessa Paquette and Chelsea Elwood (British Columbia Women’s Hospital and Health Centre, Vancouver, Canada), commented: “The study re-emphasizes safe prescribing practices in pregnancy, which include confirming the correct diagnosis and then choosing the safest medication with the largest body of data in pregnancy at the lowest appropriate doses.”

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Source: Bérard A, Sheehy O, Zhao JP et al. Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies. CMAJ. 19(191) E179–187 (2019); Paquette VC, Elwood C. The safety of oral fluconazole therapy in pregnancy. CMAJ. 19(191) E177–178 (2019).

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