According to a Canadian study, pregnant women who take oral fluconazole to treat vaginal yeast infections are more likely to have a miscarriage than women who do not take this drug during pregnancy.
In February of this year, researchers published findings in The Canadian Medical Association Journal (CMAJ) showing that about one in ten pregnant women develop a yeast infection, which is 10 times more likely than non-pregnant women. Fluconazole is often given to these women, but the use of this drug during pregnancy is associated with an increased risk of certain birth defects, including skeletal and cardiac defects.
In the article estet-portal.com you can read in detail the results of the study of the relationship between fluconazole and the risk of miscarriage.
Fluconazole during pregnancy: is it justified to prescribe the drug
Fluconazole is a triazole antifungal agent that inhibits the fungal cytochrome P-451 (CYP51) enzyme, which is required for ergosterol synthesis and fungal cell wall formation. In humans, CYP51 is required for the synthesis of cholesterol, which is essential for the human embryo and fetal tissues.
Oral fluconazole is given as a single dose of 150 mg for the treatment of vulvovaginal candidiasis and at a higher dose for systemic fungal infections.
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About 10% of pregnant women suffer from vulvovaginal candidiasis, the risk of which is 2-10 times higher than that of non-pregnant women. Topical azoles are recommended as first-line therapy during pregnancy, but low-dose oral fluconazole is often used during pregnancy because vulvovaginal candidiasis in pregnancy may be more severe and resistant to treatment.
Treatment with high doses of fluconazole during pregnancy has been associated with a clear pattern of craniofacial, skeletal and cardiac defects. Animal studies have confirmed the teratogenicity of fluconazole at high doses. In particular, the use of high doses of fluconazole during pregnancy has been associated with a pattern of major congenital malformations resembling Antley's syndrome – Bixler, a genetic disorder associated with reduced CYP51 activity due to genetic mutations.
Analysis of the risk of miscarriages, malformations and stillbirths
In a cohort of 441,949 pregnancies, 320,868 pregnancies, 226,599 major congenital malformations, and 7,832 stillbirths were included in the analysis of spontaneous abortions.
The majority (69.5%) of women exposed to fluconazole during pregnancy received the usual single therapeutic dose of 150 mg (low dose); the rest received >150mg (high dose).
Women taking low doses of fluconazole (150 mg) were more than twice as likely to have a miscarriage than women who did not use the drug during pregnancy, and women taking high doses of the drug had an increased risk of miscarriage more than 3 times.
Fluconazole exposure during the first trimester did not increase the risk of common major congenital malformations; however, high-dose exposure during the first trimester was associated with an increased risk of cardiac septal abnormalities compared with no exposure.
No association has been found between exposure to fluconazole during pregnancy and the risk of stillbirth.
Vulvovaginal candidiasis is not a cause for desperation therapy
The use of high dose fluconazole during pregnancy is contraindicated.
In general, the risk of miscarriage was higher in older women who smoked or consumed alcohol, and lower in women taking folic acid starting at least 6 months before pregnancy.
The recommended treatment for pregnant women with vaginal yeast infections is topical antifungals (clotrimazole, miconazole) administered through the vagina in the form of a cream or vaginal tablet.
Clotrimazole and miconazole creams have proven to be safe and effective in pregnant women.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Practice" section. You may be interested in Clinical case: giant intraligamentous uterine fibroids and pregnancy
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