|
 About one in 10 pregnant women develop yeast infections, a risk that
is up to 10 times higher than in nonpregnant women, researchers note
in CMAJ. While topical medicines are usually the first thing
prescribed for yeast infections, women who don't improve with this
approach may be given fluconazole even though using this drug in
pregnancy has been linked to an increased risk of certain birth
defects including skeletal and heart malformations.
For the current study, researchers examined data on 29,458
pregnancies ending in miscarriage between 6 and 19 weeks gestation
and on 245,059 pregnancies that didn't end in miscarriage.
Women who took low doses of fluconazole (150 milligrams) were more
than twice as likely to have a miscarriage as women who didn't use
this drug at all during pregnancy, and women who took higher doses
of the drug had more than triple the miscarriage risk.
"Regardless of dosage, oral fluconazole use is associated with the
risk of spontaneous abortions," said lead study author Anick Bérard
of the University of Montreal in Quebec.
The drug wasn't associated with an increased risk of stillbirth,
however, and only high doses were linked to heart defects, Bérard
noted.
"This is reassuring given that low-dose is the most frequently
used," Bérard said.
About 70 percent of the patients who received fluconazole during
pregnancy received a low dose of the drug, the study found.
All of the women in the study were pregnant in Quebec between 1998
and 2015.
Overall, the risk of miscarriage was higher when women were older,
smokers, or drinkers, and lower when women took folic acid starting
at least six months before pregnancy.
[to top of second column] |
One limitation of the study is the possibility that researchers
lacked data on all of the women who smoked or drank or took folic
acid, the study authors note. They also didn't have lab test results
confirming that women had yeast infections when they were prescribed
fluconazole.
The estimated risk of miscarriage associated with the drug may also
be low because the analysis only included miscarriages that were
diagnosed by clinicians, and many women who miscarry early in
pregnancy may not necessarily have this event detected or diagnosed
by a doctor.
Still, the results underscore the importance of pregnant women
seeking alternatives to oral fluconazole for yeast infections, said
Dr. Vanessa Paquette, coauthor of an accompanying editorial and a
pharmacy researcher at the University of British Columbia in Canada.
"The recommended treatment of choice in pregnancy for vaginal yeast
infections are topical antifungal agents (clotrimazole, miconazole)
that are administered via the vagina in the form of cream or vaginal
tablet," Paquette said by email. "These agents have been shown to be
safe and effective in pregnant women."
Even though oral fluconazole is available on drugstore shelves
without a prescription, "oral fluconazole treatment for vaginal
yeast infections in pregnant women should be avoided at this time,"
Paquette added.
SOURCE: http://bit.ly/2XfFTAy CMAJ, online February 19, 2019.
[© 2019 Thomson Reuters. All rights
reserved.] Copyright 2019 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
