ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2019
Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case-control studies.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Risk of congenital malformations and miscarriages following maternal use of oral fluconazole during the first trimester of pregnancy: a systematic review and meta-analysis.European journal of epidemiology · 2024Pooled it
- Sexually Transmitted Infections Treatment Guidelines, 2021.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2021Guideline
- Comparison of Pregnancy Outcomes of Patients Treated With Ondansetron vs Alternative Antiemetic Medications in a Multinational, Population-Based Cohort.JAMA network open · 2021Pooled it
- Phase 2 Randomized Study of Oral Ibrexafungerp Versus Fluconazole in Vulvovaginal Candidiasis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Trial
- Ibrexafungerp Versus Placebo for Vulvovaginal Candidiasis Treatment: A Phase 3, Randomized, Controlled Superiority Trial (VANISH 303).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Trial
- Antifungal activity of propolis against Candida spp.New microbes and new infections · 2026Review
- The Potential Role of Verapamil Against Fluconazole-Induced Torsade de Pointes: A Critical Review.Health science reports · 2026Article
- Risk assessment of drug-associated miscarriage using XGBoost and SHAP explainability: a real-world pharmacovigilance analysis based on the FAERS database.Frontiers in pharmacology · 2026Article
- Article
- Patterns of Yeast Infections and Antifungal Use in the First Trimester of Pregnancy: Findings from the Birth Defects Study to Evaluate Pregnancy exposureS, 2014-2019.Journal of women's health (2002) · 2025Article
- Onychomycosis in special populations.Future microbiology · 2025Review
- Protective efficacy of the pan-fungal vaccine NXT-2 against vulvovaginal candidiasis in a murine model.NPJ vaccines · 2025Article
- Severe oropharyngeal candidiasis in an anemic pregnant woman: A case report.Medical mycology case reports · 2025Article
- Review
- Antifungal medication use during pregnancy and the risk of selected major birth defects in the National Birth Defects Prevention Study, 1997-2011.Pharmacoepidemiology and drug safety · 2024Article
- Coccidioidomycosis: A Contemporary Review.Infectious diseases and therapy · 2022Review
- Common Antifungal Drugs in Pregnancy: Risks and Precautions.Journal of obstetrics and gynaecology of India · 2021Review
- Less common bacterial, fungal and viral infections: review of management in the pregnant patient.Drugs in context · 2021Review
- Oral fluconazole use in the first trimester and risk of congenital malformations: population based cohort study.BMJ (Clinical research ed.) · 2020Article
- Fluconazole Prophylaxis in Prevention of Symptomatic Candida Vaginitis.Current infectious disease reports · 2020Review
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile topical azoles are the first-line treatment for fungal infections, oral fluconazole is frequently used during pregnancy. We aimed to assess the effect of exposure to low and high doses of fluconazole during pregnancy on the occurrence of spontaneous abortions, major congenital malformations and stillbirths.
methodsWithin the Quebec Pregnancy Cohort (1998-2015), we identified women exposed to low- (≤ 150 mg) and high-dose (> 150 mg) fluconazole, and women who were not exposed. For each case of spontaneous abortion or stillbirth, up to 5 controls were randomly selected using an incidence density sampling method matched on gestational age at diagnosis of spontaneous abortion or stillbirth (index date) and the year of the last menstrual period. For cases of major congenital malformation, we considered all liveborn babies as controls. Generalized estimation equation models were used to analyze the 3 main outcomes separately.
resultsWithin a cohort of 441 949 pregnancies, 320 868 pregnancies were included in the analyses of spontaneous abortions, 226 599 of major congenital malformations and 7832 of stillbirths. Most (69.5%) women exposed to fluconazole in pregnancy received the common single therapeutic dose of 150 mg (low dose); the remainder received a dose of > 150 mg (high dose). Use of oral fluconazole during early pregnancy was associated with an increased risk of spontaneous abortion compared with no exposure (adjusted odds ratio [OR] for 345 cases exposed to low-dose treatment 2.23, 95% confidence interval [CI] 1.96-2.54; adjusted OR for 249 cases exposed to high-dose treatment 3.20, 95% CI 2.73-3.75). Exposure to fluconazole during the first trimester did not increase the risk of overall major congenital malformations; however, exposure to a high dose during the first trimester was associated with an increased risk of cardiac septal closure anomalies (adjusted OR 1.81, 95% CI 1.04-3.14; 13 exposed cases) compared with no exposure. No association was found between exposure to fluconazole during pregnancy and the risk of stillbirth.
interpretationAny maternal exposure to fluconazole during pregnancy may increase risk of spontaneous abortion and doses higher than 150 mg during the first trimester may increase risk of cardiac septal closure anomalies.
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