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Musculoskeletal Malformations Up With Fluconazole in Pregnancy

But no increase seen in conotruncal malformations, oral clefts with use of oral fluconazole in first trimester

THURSDAY, May 21, 2020 (HealthDay News) — Use of oral fluconazole for treatment of vulvovaginal candidiasis in the first trimester of pregnancy is associated with musculoskeletal malformations, but not with oral clefts or conotruncal malformations, according to a study published online May 20 in The BMJ.

Yanmin Zhu, Ph.D., from Brigham and Women’s Hospital in Boston, and colleagues conducted a population-based study to examine the risk for congenital malformations associated with exposure to oral fluconazole at commonly used doses for treatment of vulvovaginal candidiasis in the first trimester of pregnancy. The study cohort included 1,969,954 pregnancies, of which 1.9 percent were exposed to oral fluconazole and 4.2 percent were exposed to topical azoles in the first trimester.

The researchers found that the risk for musculoskeletal malformations was 52.1 versus 37.3 per 10,000 pregnancies exposed to fluconazole versus topical azoles. The corresponding risks for conotruncal malformations were 9.6 versus 8.3 per 10,000 pregnancies, and risks for oral clefts were 9.3 versus 10.6 per 10,000 pregnancies. After fine stratification of the propensity score, the adjusted relative risk was 1.30 (95 percent confidence interval, 1.09 to 1.56) for musculoskeletal malformations, 1.04 (95 percent confidence interval, 0.70 to 1.55) for conotruncal malformations, and 0.91 (95 percent confidence interval, 0.61 to 1.35) for oral clefts.

“Oral fluconazole during the first trimester, especially prolonged treatment at higher than commonly used doses, should be prescribed with caution, and topical azoles should be considered as an alternative treatment,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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