Use of Oral Antifungal Medication during Pregnancy Can Increase Risk of Miscarriage

In Denmark, an analysis of approximately 1.4 million pregnant women found the use of the oral antifungal medication fluconazole, during pregnancy was associated with an increased risk of miscarriage, when compared to the risk among women who are not exposed and those who used a topical antifungal medication.

The results of the study were published in the January 5th, 2016 edition of the Journal of the American Medical Association.

The Facts

A pregnant woman is at an increased risk of a yeast infection, because of the presence of vaginal candidiasis. Although intravaginal formulations of topical azole antifungals are the first method of treatment for pregnant women, oral fluconazole is often used in spite of limited safety information. Ditte Molgaard-Nielsen, M. Sc., of the Statens Serum Institut, in Copenhagen, Denmark and his colleagues evaluated the association between oral fluconazole exposure during pregnancy and the risk of miscarriage and stillbirth.

The study included 1,405,663 pregnancies in Denmark from 1997 through 2013. From these participants, oral fluconazole-exposed pregnancies were compared to up to 4 unexposed pregnancies, based on maternal age, gestational age and calendar year. The information from filled fluconazole prescriptions was obtained from the National Prescription Register.

Results of the Study

Among 3,315 women exposed to oral antifungal medication from 7-22 weeks’ gestation, 147 experienced a miscarriage, compared with 563 among 13,246 unexposed matched women. There was a large increase in the risk of spontaneous abortion or miscarriage associated with fluconazole exposure. Of the 5,382 women exposed to the drug from gestational week 7 to birth, 21 had a stillbirth, compared with 77 among 21,506 unexposed matched women. There was no significant association between exposure to fluconazole and stillbirth.

Using topical azole exposure as means of comparing, 130 of 2,823 women exposed to fluconazole verses 118 of 2,823 women exposed to fluconazole verses 22 of 4,301 exposed to topical azoles had a stillbirth.

Conclusion to the Study

The authors of the study write: “In this nationwide cohort in Denmark, oral fluconazole use in pregnancy was associated with an increased risk of spontaneous abortion. 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.”

If you are a pregnant woman and experiencing recurrent issues with yeast infections, it is a good idea to speak to your obstetrician about medications that can help you. Rather than trying to self-treat a yeast infection while pregnant, it’s important to be mindful of the above information and to seek medical attention when needed.