Thrush during pregnancy is a fairly common experience for many women.
Bodily changes during pregnancy, such as an increase in glycogen (a type of glucose that feeds yeast) in the vagina, mean an increased risk of this uncomfortable fungal infection.
Many women will go on to use some form of anti-fungal medication to ease the symptoms and get rid of the microscopic fungus that causes thrush.
However, some medications are considered safer than others. A recent study has shown that oral forms of the drug fluconazole used to treat thrush may increase the risk of miscarriages if taken during the early stages of pregnancy.
Increased Risk Of Miscarriage?
The Danish study took place over 17 years, involving over one million pregnancies. The researchers compared pregnant women who had used oral fluconazole to pregnant women who had not used the prescription drug.
The research found almost 50% of women who used oral fluconazole in the first 6 months of pregnancy were more likely to have a miscarriage than the women who did not use the drug.
In 2011, the US Food and Drug Administration changed the pregnancy category of oral fluconazole from C to D — except for use for thrush. This followed several reports of birth defects in babies whose mothers had been treated with high-dose fluconazole (400-800 mg/day). The women had serious and life-threatening fungal infections during the first trimester.
Pregnancy category D means there is positive evidence of risk to human fetuses based on human data. However, doctors may decide to accept these risks in serious or life threatening situations due to the potential benefits from use of the drug.
Treatments For Thrush
Vaginal and topical anti-fungal creams are usually the first-line treatment for pregnant women with thrush. Despite the lack of safety information about oral fluconazole, the drug is often prescribed for thrush during pregnancy, especially if the infection is recurring.
A single dose of 150mg is considered by the FDA to be safe for use by women and has a pregnancy category C. It’s believed that at this level there is no increased risk of birth defects in babies.
Yet the Danish study showed women who were on the single 150mg dose were still at increased risk of miscarriage. Women on higher doses had a greater risk.
Oral fluconazole-exposed pregnancies in the group were compared with up to four unexposed pregnancies matched by calendar year, maternal age and gestational age.
Of the 3315 women who were exposed to oral fluconazole between 7-22 weeks of pregnancy, 147 experienced miscarriage. This is compared to 563 miscarriages among 13,246 women who were not exposed to anti-fungal medication.
What Is Thrush?
Thrush is more common in pregnant women. We carry the fungus or yeast called candida albicans living in and on our bodies all the time and our good bacteria keeps it under control.
During pregnancy, many changes occur to a woman’s body and one of those can be the balance of micro-organisms in the vagina. Normal levels of good bacteria Lactobacillus keep the Ph levels in the vagina low, which discourages infectious bacteria from taking hold. This occurs naturally to prevent bacteria travelling through the cervix and into the uterus, which can have devastating affects.
Pregnancy hormones and higher levels of glycogen (a type of sugar) can knock out the balance of good and bad micro-organisms. If lower levels of Lactobacillus are present and the Ph levels are higher, an overgrowth of candida albicans can take hold, causing vaginal thrush.
While it’s important not to let thrush go unchecked if you are pregnant, medications for treatment should be used carefully. While they’ll kill off the bacteria causing the thrush, they can also kill your good bacteria that can prevent further occurrences of thrush. It also wont address the root cause of the thrush, which is more likely to stay away with a diet lower in sugars. Avoiding foods like sugar and processed grains is important. Find out more in our article, Thrush Treatment – Get Rid of Thrush For Good (Yes, It’s True!)
Your doctor or midwife may take a swab from your vagina to confirm a thrush diagnosis. There are anti-fungal pessaries or creams you can use depending on your pregnancy gestation.
While the recent study has not provided proof of harm using oral fluconazole during pregnancy, caution should be used when prescribing this medication. If your care provider suggests using this medication for thrush during pregnancy, ask about alternative treatments if possible.