Anti-fungal drug not tied to most birth defects, study says

August 28, 2013 by Steven Reinberg, Healthday Reporter
Anti-fungal drug not tied to most birth defects: study
But experts may still avoid prescribing fluconazole for pregnant women since it's still linked to a rare heart defect.

(HealthDay)—Although some reports have shown that high doses of the anti-fungal drug fluconazole (Diflucan) may raise the risk of birth defects, a new Danish review finds that more commonly prescribed lower doses of the medicine do not carry the same dangers.

Yet, in spite of this reassurance, experts may remain reluctant to prescribe the drug for expectant mothers who have , since it is still linked to an increased risk of a rare congenital heart problem called tetralogy of Fallot.

"Many pregnant women suffer from a yeast infection called vaginal candidiasis, or vaginal thrush, which is the most common clinical indication for use of oral ," explained lead researcher Ditte Molgaard-Nielsen, an epidemiologist at the Statens Serum Institute in Copenhagen.

First-line treatment for vaginal candidiasis during pregnancy is vaginal preparations of topical anti-fungal drugs, she noted.

"However, in cases when topical treatment is ineffective this study provides comprehensive safety information, and may help inform when treatment with oral fluconazole is considered in pregnancy," Molgaard-Nielsen said.

Specifically, the researchers looked at 15 linked to fluconazole and found it was not associated with an increased risk for 14 of them, she said.

"However, we did see an increase in the risk of tetralogy of Fallot, an uncommon , but the number of exposed cases were few and this association should be confirmed in other studies before anything can be concluded with any certainty," Molgaard-Nielsen added.

The report was published Aug. 29 in the New England Journal of Medicine.

Dr. Scott Berns, senior vice president and deputy medical officer for the March of Dimes, said that "when pregnant it is important to avoid taking any medicines unnecessarily."

"I would chose the topical drug to treat a yeast infection. That is my first line," he said. "If I had to use oral fluconazole, this study is reassuring that most of the time the baby is going to be fine. But, there is that small chance of tetralogy of Fallot. So, why take that chance?"

Another expert doesn't think these findings will change clinical practice.

"Ob/Gyns are still going to be reluctant to prescribe this drug," said Dr. Kecia Gaither, director of maternal fetal medicine at Brookdale University Hospital and Medical Center in Brooklyn, N.Y.

Gaither prefers to use natural methods for treating yeast infections. "One of them is increasing the use of yogurt intake," she said. "There is certain bacteria in yogurt that prevents yeast infections. I have not run into a person who continues to have recurrent yeast infections after that is done."

For the study, Molgaard-Nielsen's team collected data on more than 7,300 women who took fluconazole during their pregnancy, among whom 210 infants were born with birth defects, and compared them to a control group of more than 968,000 unexposed women, among whom more than 25,000 babies were born with birth defects.

In both groups, the risk for having an infant with a birth defect was 0.6 percent, the researchers found.

Moreover, fluconazole wasn't linked to a significantly increased risk for 14 of 15 birth defects to which the drug had been previously linked, they added.

These include craniosynostosis (a defect in the baby's skull), middle ear defects, cleft palate, cleft lip, limb defects, an abnormal number of finger or toes, fused fingers or toes, diaphragmatic hernia, heart defects and shifting of a lung.

There was, however, a significantly increased risk of tetralogy of Fallot, with seven cases (0.10 percent) among women who took fluconazole, compared with 287 cases (0.03 percent) in unexposed women, the researchers found.

According to the U.S. National Institutes of Health, tetralogy of Fallot is a rare, complex birth defect where four different areas of the heart are malformed and the heart cannot pump enough blood or oxygen to the rest of the body. Surgery is usually required shortly after birth, although the long-term outlook for these patients has improved greatly in recent years.

Explore further: Epilepsy drug dosage linked to specific birth defects

More information: For more on vaginal candidiasis, visit the U.S. Centers for Disease Control and Prevention.

Related Stories

Epilepsy drug dosage linked to specific birth defects

August 25, 2013
In a world first, new Australian medical research has given pregnant women with epilepsy new hope of reducing their chance of having a baby with physical birth defects.

Stress during pregnancy may raise heart defect risk for baby

March 25, 2013
(HealthDay)—Stress in mothers before and during pregnancy may boost the risk of congenital heart defects in their children, more new evidence suggests. But the findings aren't conclusive, and the effect—if it exists—appears ...

Major birth defects associated with moderately increased cancer risk in children

August 12, 2013
A multistate study led by researchers at the University of Utah has revealed that the risk for childhood cancer is moderately increased among children and young adolescents with certain types of major birth defects. Children ...

Prenatal use of newer antiepileptic drugs not associated with increased risk of major birth defects

May 17, 2011
Use of newer-generation antiepileptic drugs, which are also prescribed for bipolar mood disorders and migraine headaches, during the first trimester of pregnancy was not associated with an increased risk of major birth defects ...

Planning pregnancy may cut birth defects

April 6, 2012
(HealthDay) -- Women who'd like to become pregnant -- especially those who are taking medications for chronic conditions -- may need to add something to their to-do list: Plan, plan, plan.

Recommended for you

Study suggests ending opioid epidemic will take years

July 20, 2017
The question of how to stem the nation's opioid epidemic now has a major detailed response. A new study chaired by University of Virginia School of Law Professor Richard Bonnie provides extensive recommendations for curbing ...

Team-based model reduces prescription opioid use among patients with chronic pain by 40 percent

July 17, 2017
A new, team-based, primary care model is decreasing prescription opioid use among patients with chronic pain by 40 percent, according to a new study out of Boston Medical Center's Grayken Center for Addiction Medicine, which ...

Private clinics' peddling of unproven stem cell treatments is unsafe and unethical

July 7, 2017
Stem cell science is an area of medical research that continues to offer great promise. But as this week's paper in Science Translational Medicine highlights, a growing number of clinics around the globe, including in Australia, ...

Popular heartburn drugs linked to higher death risk

July 4, 2017
Popular heartburn drugs called proton pump inhibitors (PPIs) have been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia. Now, a new study from Washington University School ...

Most reproductive-age women using opioids also use another substance

June 30, 2017
The majority of reproductive-age and pregnant women who use opioids for non-medical purposes also use at least one other substance, ranging from nicotine or alcohol to cocaine, according to a University of Pittsburgh Graduate ...

At-risk chronic pain patients taper opioids successfully with psychological tools

June 28, 2017
Psychological support and new coping skills are helping patients at high risk of developing chronic pain and long-term, high-dose opioid use taper their opioids and rebuild their lives with activities that are meaningful ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.