Prenatal Fluconazole Exposure Increases Neonatal Risks
Any exposure increases spontaneous abortion risk; cardiac septal defects up for use in early pregnancy
WEDNESDAY, Feb. 20, 2019 (Pharmacist's Briefing) -- Maternal exposure to fluconazole during pregnancy may increase the risk for spontaneous abortion, according to a study published online Feb. 19 in CMAJ, the journal of the Canadian Medical Association.
Anick Bérard, Ph.D., from the University of Montreal, and colleagues examined the impact of exposure to fluconazole during pregnancy on the occurrence of spontaneous abortions, major congenital malformations, and stillbirths within a cohort of 441,949 pregnancies.
The researchers found that 69.5 percent of women exposed to fluconazole in pregnancy received low-dose (≤150 mg) fluconazole and the remainder received high-dose (>150 mg) fluconazole. Compared with no exposure, use of oral fluconazole during early pregnancy was associated with an increased risk for spontaneous abortion (adjusted odds ratio, 2.23 for 345 cases exposed to low-dose treatment; adjusted odds ratio, 3.2 for 249 cases exposed to high-dose treatment). There was no correlation between exposure to fluconazole during the first trimester and increased risk for overall major congenital malformations; compared with no exposure, exposure to high-dose treatment in the first trimester was correlated with an increased risk for cardiac septal closure anomalies (adjusted odds ratio, 1.81). There was no correlation between fluconazole exposure and risk for stillbirth.
"If treatment is indicated, a risk-benefit discussion should take place, but appropriate treatment should not be deferred if indicated," write the authors of an accompanying editorial. "A healthy mom is required for a healthy baby."