Oral Fluconazole in Pregnancy and Risk of Stillbirth and Neonatal Death

Pasternak, Björn; Wintzell, Viktor; Furu, Kari; Engeland, Anders; Neovius, Martin; Stephansson, Olof

doi:10.1001/jama.2018.6237

Cited by 18 publications

(15 citation statements)

References 5 publications

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“…37 Our findings pertaining to spontaneous abortion and stillbirth are consistent with 2 Danish nationwide cohort studies. 40,41 Both studies found no association between exposure to fluconazole, regardless of dosage, and stillbirth. However, Mølgaard-Nielsen and colleagues 40 showed that more spontaneous abortions occurred among women exposed to oral fluconazole than in those given topical azoles (hazard ratio 1.62, 95% CI 1.26-2.07, 130 exposed cases).…”

Section: Discussionmentioning

confidence: 97%

Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies

Berard

Sheehy

Zhao

et al. 2019

CMAJ

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Section: Discussionmentioning

confidence: 97%

Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies

Berard

Sheehy

Zhao

et al. 2019

CMAJ

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“…25 Stillbirth (antepartum and intrapartum fetal death) was defined as fetal loss after 28 completed weeks (until June 2008), but that was changed to fetal loss after 22 completed weeks since July 2008. 26 SGA was defined as a birthweight below 2 standard deviations (SDs) of the mean birthweight of the sex-specific and gestational age distributions.…”

Section: Outcome Measuresmentioning

confidence: 99%

Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study

Khalaf¹,

O’Reilly²,

McCarthy³

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: Maternal chronic kidney disease and chronic hypertension have been linked with adverse pregnancy outcomes. We aimed to examine the association between these conditions and adverse pregnancy outcomes over the last 3 decades. OBJECTIVE: We conducted this national cohort study to assess the association between maternal chronic disease (CH, CKD or both conditions) and adverse pregnancy outcomes with an emphasis on the effect of parity, maternal age, and BMI on these associations over the last three decades. We further investigated whether different subtypes of CKD had differing effects. STUDY DESIGN: We used data from the Swedish Medical Birth Register, including 2,788,490 singleton births between 1982 and 2012. Women with chronic kidney disease and chronic hypertension were identified from the Medical Birth Register and National Patient Register. Logistic regression models were performed to assess the associations between maternal chronic disease (chronic hypertension, chronic kidney disease, or both conditions) and pregnancy outcomes, including preeclampsia, in-labor and prelabor cesarean delivery, preterm birth, small for gestational age, and stillbirth. RESULTS: During the 30-year study period, 22,397 babies (0.8%) were born to women with chronic kidney disease, 13,279 (0.48%) to women with chronic hypertension and 1079 (0.04%) to women with both conditions. Associations with chronic hypertension were strongest for preeclampsia (adjusted odds ratio, 4.57; 95% confidence interval, 4.33e4.84) and stillbirth (adjusted odds ratio, 1.65; 95% confidence interval, 1.35e2.03) and weakest for spontaneous preterm birth (adjusted odds ratio, 1.07; 95% confidence interval, 0.96e1.20). The effect of chronic kidney disease varied from (adjusted odds ratio, 2.05; 95% confidence interval, 1.92e2.19) for indicated preterm birth to no effect for stillbirth (adjusted odds ratio, 1.16; 95% confidence interval, 0.95e1.43). Women with both conditions had the strongest associations for in-labor cesarean delivery (adjusted odds ratio, 1.86; 95% confidence interval, 1.49e2.32), prelabor cesarean delivery (adjusted odds ratio, 2.68; 95% confidence interval, 2.18e3.28), indicated preterm birth (adjusted odds ratio, 9.09; 95% confidence interval, 7.61e10.7), and small for gestational age (adjusted odds ratio, 4.52; 95% confidence interval, 3.68e5.57). The results remained constant over the last 3 decades. Stratified analyses of the associations by parity, maternal age, and body mass index showed that adverse outcomes remained independently higher in women with these conditions, with worse outcomes in multiparous women. All chronic kidney disease subtypes were associated with higher odds of preeclampsia, in-labor cesarean delivery, and medically indicated preterm birth. Different subtypes of chronic kidney disease had differing risks; strongest associations of preeclampsia (adjusted odds ratio, 3.98; 95% confidence interval, 2.98e5.31) and stillbirth (adjusted odds ratio, 2.73; 95% confidence interval, 1.13e6.59) were observed in...

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“…However, it must be taken into account that fluconazole and amphotericin B deoxycholate were the only available agents in the early years of the reviewed cases. Fluconazole has on rare occasions been associated with severe hepatotoxicity [39]. Hence, liver function tests should be performed regularly during prolonged fluconazole therapy, while amphotericin B, although an effective broad spectrum regimen, is relatively toxic, and its side effects-including renal dysfunction-may restrict its long-term use, which is essential for PJI cases [40].…”

Section: Discussionmentioning

confidence: 99%

Non-Candida Fungal Prosthetic Joint Infections

et al. 2021

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Background: Fungal prosthetic joint infections (PJIs) are rare, especially those caused by non-Candida species. Treatment has not been fully elucidated, since a plethora of antifungal and surgical interventions have been proposed. Τhis study represents an effort to clarify the optimal management of non-Candida fungal PJIs, by reviewing all relevant published cases. Methods: A thorough review of all existing non-Candida fungal PJIs in the literature was conducted. Data regarding demographics, responsible organisms, antifungal treatment (AFT), surgical intervention, time between initial arthroplasty and onset of symptoms, and time between onset of symptoms and firm diagnosis, as well as the infection’s outcome, were evaluated. Results: Forty-two PJIs, in patients with mean age of 66.2 years, were found and reviewed. Aspergillus spp. were isolated in most cases (10; 23.8%), followed by Coccidioides spp. (7; 16.7%) and Pichiaanomala (5; 11.9%). Fluconazole was the preferred antifungal regimen (20 cases; 47.6%), followed by amphotericin B (18 cases; 42.9%), while the mean AFT duration was 9.4 months (SD = 7.06). Two-stage revision arthroplasty (TSRA) was performed in 22 cases (52.4%), with the mean time between stages being 5.2 months (SD = 2.9). The mean time between initial joint implantation and onset of symptoms was 42.1 months (SD = 50.7), while the mean time between onset of symptoms and diagnosis was 5.8 months (SD = 14.3). Conclusions: Non-Candida fungal PJIs pose a clinical challenge, demanding a multidisciplinary approach. The present review has shown that combination of TSRA separated by a 3–6-month interval and prolonged AFT has been the standard of care in the studied cases.

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Oral Fluconazole in Pregnancy and Risk of Stillbirth and Neonatal Death

Cited by 18 publications

References 5 publications

Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies

Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies

Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study

Non-Candida Fungal Prosthetic Joint Infections

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