A recent CMAJ publication by Bérard et al.
1 has again highlighted that clinicians must exert caution and carefully consider alternative antifungal preparations prior to prescribing or recommending fluconazole during pregnancy. This study reports on a large Canadian cohort of over three hundred thousand pregnancies and demonstrates, similar to previous literature, an association between the use of oral fluconazole and adverse pregnancy outcomes. In particular, this data demonstrates that the use of low-dose fluconazole (<150 mg) and high-dose fluconazole (>150mg) was associated with an increased risk of spontaneous abortion (aOR 2.23, 95% CI 1.96-2.54 and aOR 3.20, 95% CI 2.73-3.75, respectively).
Because of ongoing safety concerns, the Infectious Diseases Committee of the SOGC recommends avoiding the use of fluconazole during pregnancy where possible. The first line of treatment for vulvovaginal candidiasis during pregnancy remains topical azoles. While self-diagnosis and treatment of VVC is not recommended, it may be helpful for clinicians to remind women who are or may become pregnant that oral treatment with fluconazole carries risk.
1 A Bérard, S Odile, J-P Zhao, J Gorgui, S Bernatshy, C Soares, M Abrahamowicz. (2018) Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case-control studies. CMAJ; 191(7):E179-E187.