Can I use Nitrofurantoin during pregnancy? and are there any alternatives to the drug?

Yes. Nitrofurantoin can be taken during pregnancy, but it is usually best avoided in the later stages of pregnancy as it is likely to cause problems with the baby's red blood cells. Medical research generally defines Nitrofurantoin as an antibiotic that is safe to use during the first trimester of pregnancy, but again, there are concerns from patients that exposure to nitrofurantoin during the first trimester of pregnancy may cause congenital malformations. In response to these concerns, the investigators conducted a series of large population-based retrospective cohort studies to evaluate this possible association (including cases of medical termination of pregnancy or stillbirth) and congenital malformations. The results of the study indicated that exposure to nitrofurantoin was not associated with an increased risk of overall major malformations or with specific malformations.

However, although no association between foetal exposure to nitrofurantoin and major malformations was found in cohort studies, there was a slight but significant teratogenic risk in case-control studies, which are more sensitive to adverse effects. Fosfomyciny is also a first-line antimicrobial agent for the treatment of urinary tract infections, and studies have shown that the use of a single dose of fosfomycine is more effective than a standard dose of nitrofurantoin in the treatment of urinary tract infections in pregnancy. Fosfomycin has been shown to have fewer side effects and lower rates of microbial resistance than Nitrofurantoin. It does not exhibit an increased risk of major Congenital Anomaly (CA) after fosfomycin exposure during the first trimester of pregnancy.

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