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(Date of issue: June 2017, Version: 3.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on nitrofurantoin use in pregnancy is available at


Nitrofurantoin is an antibiotic used for the treatment of, and prophylaxis against, acute or recurrent uncomplicated lower urinary tract infections (UTIs) or pyelitis. It is specifically indicated for the treatment of infections due to susceptible strains of Escherichia coli, Enterococcus, Staphylococcus, Citrobacter, Klebsiella and Enterobacter.

There is no strong evidence of an association between in utero nitrofurantoin exposure and an overall increased risk of congenital malformations or of any specific type of malformation. Individual studies have suggested a possible increased risk of hypoplastic left heart, talipes, hypospadias, an/microphthalmia, ASD, and cleft lip/palate; however these findings have not been confirmed in other studies and the increase in risk (if any) of congenital malformations following exposure to nitrofurantoin is likely to be small, especially given that systemic absorption and transfer to the fetus is low.

No increased risk of spontaneous abortion, intrauterine death, low birth weight or preterm delivery has been identified, although an increased incidence of neonatal jaundice has been observed in infants exposed to nitrofurantoin in the month preceding delivery. No studies have investigated the risk of adverse neurodevelopmental outcomes.

Nitrofurantoin in the non-pregnant patient can, in rare cases, cause serious adverse reactions including peripheral neuropathy, pulmonary toxicity, and fatal hepatic injury. It has also been associated with haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Nitrofurantoin use is generally avoided in pregnant patients during labour and delivery because of the theoretical possibility of haemolytic anaemia in the fetus, or in the neonate due to immature erythrocyte enzyme systems.

Where possible, antibiotic choice should be informed by culture and sensitivity tests, however if treatment is required urgently or before test results become available, then nitrofurantoin may be considered where clinically appropriate. Any risks to the fetus from the drugs used to treat maternal UTI should be weighed against the potential adverse effects for the mother and fetus from an untreated infection. The decision as to which drug is chosen should be based on the clinical condition of the pregnant woman and local prescribing guidelines.

Exposure to nitrofurantoin at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from or to ensure you are using the most up-to-date version.