An Antifungal for Fungal Infections Linked to Risk of Pregnancy Loss
By Oral drug fluconazole may increase risk, Danish researchers report
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TUESDAY, Jan. 5, 2016 (HealthDay News) – A well-known antifungal used for vaginal yeast infections may be linked to a slightly higher risk of pregnancy loss, according to a study of more than 1.4 million pregnancies in Denmark.
Of the more than 3,300 women who took oral fluconazole (Diflucan) between 7 and 22 weeks of pregnancy, 147 had a miscarriage, compared with 563 pregnancy losses among the more than 13,000 women who didn’t take the drug, the researchers found.
“From our study, we can only see that women who have been treated with oral fluconazole experience pregnancy loss more often than untreated women and women who used a topical [vaginal] antifungal,” said lead researcher Ditte Molgaard-Nielsen, an epidemiologist at the Statens Serum Institute in Copenhagen.
But the study cannot prove that fluconazole causes miscarriages, she added.
“Our findings cannot precisely show whether fluconazole causes pregnancy loss or not. We cannot rule out that women treated with fluconazole will differ from women not treated with the drug with respect to other issues associated with an increased risk of miscarriage,” Molgaard-Nielsen said.
He added that until more data are available on the association between fluconazole and the risk of pregnancy loss, the drug should be prescribed with caution to pregnant women.
The report is published in the Jan. 5 issue of the Journal of the American Medical Association.
Vaginal yeast infections are common during pregnancy. In the United States, an estimated 10 percent of pregnant women get one. The treatment is a topical antifungal cream or the oral drug fluconazole, Molgaard-Nielsen said.
“Topical antifungals (vaginal suppositories) are the first-line treatment for pregnant women, but a small number of pregnant women receive oral fluconazole treatment, for example in cases of recurrence, severe symptoms or when topical treatment does not work. But oral fluconazole could also be used as a first treatment because of personal preference,” she said.
Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City, said that fluconazole is the only oral drug used to treat fungal infections.
“Women who are trying to get pregnant or who are already pregnant should avoid fluconazole,” Wu said. “In those women, a topical drug is the preferred treatment.
The researchers also looked at the association between fluconazole and stillbirths. Although fluconazole was linked to an increased risk of miscarriage, it did not significantly increase the risk of having a stillbirth, Molgaard-Nielsen said. Among more than 5,300 women who took fluconazole between the seventh week of pregnancy and delivery, 21 had a stillbirth, compared with 77 stillbirths among the more than 21,500 women who didn’t use the drug.
“Although the risk of stillbirth did not increase significantly, more research should be done,” she added.
For the study, Molgaard-Nielsen and his collaborators collected data on more than 1.4 million pregnancies between 1997 and 2013. They compared women who used oral fluconazole during pregnancy with those who did not.
Dr. Jill Rabin, joint chief of the outpatient division of Women’s Health Programs and PCAP Services at Northwell Health in New Hyde Park, N.Y., said she prefers to use topical treatments for fungal infections because of fluconazole’s side effects, which include flu-like symptoms.
Rabin said that not all vaginal yeast infections are the same, and treatment should be targeted to the specific type of infection.
Also, symptoms that appear to be a yeast infection may be something else, he added. “Women should not assume that if they have discharge and itching it is a yeast infection,” Rabin said.
Rabin cautioned that such symptoms should not be treated with over-the-counter drugs. “Women should not try to treat themselves, especially if they are pregnant,” he said. “You should talk to your doctor, not go to Dr. Google.
Article by HealthDay
SOURCES: Ditte Molgaard-Nielsen, M.Sc., epidemiologist, Statens Serum Institute, Copenhagen, Denmark; Jill Rabin, M.D., co-chief, division of ambulatory care, Women’s Health Programs-PCAP Services, Northwell Health, New Hyde Park, N.Y.; Jennifer Wu, M.D., obstetrics and gynecology, Lenox Hill Hospital, New York City; Jan. 5, 2016, Journal of the American Medical Association