No stillbirth rise from antifungal medication

June 27, 2018 - 06:20

Pregnant women who use the oral medication flucanozole against fungal infections run a higher risk of spontaneous abortions. But fortunately, this medication for treating vaginal yeast problems does not raise risks of stillbirths or deaths among new-born infants, according to a large Swedish-Norwegian study.

Pregnant women who orally use flucanozole against fungal infections are not at risk of stillbirths and neonatal deaths. (Illustrative photo: Valeria Aksakova, Shutterstock, NTB scanpix)

Pregnant women can often contract vaginal yeast infections. Their initial choice of a treatment against such fungal problems is often an over-the-counter cream or ointment.

But oral tablets are the next step with more serious symptoms and persistent infections or when vaginal treatments just don’t work – usually of medication flucanozole.  

Although pregnant women are generally advised not to take flucanozole in tablet form, the study shows that about one-half of one percent, that’s 0.5%, of pregnant women in the Nordic countries do use the drug.

In 2016 a study based on data from the Danish National Health Service Register showed that this pill can raise the risk of spontananeous abortions.

That risk increased by 48 percent against the normal frequency of spontaneous abortions. This brought about a revision of the product information for the drug. 

No increased risk of neonatal deaths

The Danish health data study did not give any definite answer to the question of whether fluctonazole tablets upped risks of stillbirths and neonatal deaths.

“That’s why we wanted to investigate this matter more thoroughly with Norwegian and Swedish data,” explains Senior Researcher Kari Furu of the Norwegian Institute of Public Health (NIPH).

Researchers at NIPH joined forces with colleagues at Sweden’s Karolinska Institute in a new study that used twice the cohort, or number of individuals, that formed the basis for the Danish study in 2016.

The new study found no link between treatment with the antifungal medication fluconazole and elevated risk of stillbirths or neonatal deaths. The Norwegian-Swedish study was published in the journal JAMA this week.

“This is an important finding,” asserts Furu.

More common in the USA

Common dosages are 150 mg or 300 mg per treatment. They uncovered no differences in the outcome related to the dosages.

The researchers write the results were the same for doses ranging from 30 mg or less and up to those above 300 mg.

However, they stress that there were few pregnant women who were treated with higher doses than 300 mg.

Studies show that from 0.5 to 4 percent of all pregnant women use this medication. The lowest rates of usage are reported among the Nordic countries and the highest are seen in the USA.

“Even though we stop suspecting the medication from elevating risks of stillbirths and neonatal deaths, one needs to consider other potential risks with fluconazole when these interpreting these findings. Birth defects could be another risk.”

Furu underscores that more research is really needed before anyone can issue usage recommendations to clinicians and to pregnant women.

Find out if it’s fungal or bacterial

Yeast infections cause an unpleasant odour, itching and discharges similar to cottage cheese.

Something to have in mind to avoid over-treatment with persistent and recurrent problems is to check out vaginal infections by microscope or by cultivation of a culture. This enables doctors to determine the species of micro-organism and see whether it is a multi-resistant strain.

The patient must be examined for predisposed factors such as an undiagnosed diabetes or some other disease, according to medical guidebooks.  

Is it best to avoid using a medication altogether?

“Yes, that is best. But with serious fungal infections the physician administering treatment and the pregnant woman need to consider what can be of help. So this study provides some important information on this regard,” states Furu.

Vaginal infections can also be caused by bacteria rather than a yeast (a fungus). In such cases the discharges are also smelly. Bacterial infections in the vagina early in pregnancies are probably associated with a higher risk of later abortions and premature births, according to medical textbooks.

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Read the Norwegian version of this article at forskning.no.

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Translated by
Glenn Ostling