Exposure to antifungals Clotrimazole and miconazole during pregnancy for Vulvovaginal candidiasis (VVC) is not associated with increased risk of spontaneous abortion says the results of a cohort study published in June issue of American Journal of Obstetrics and Gynecology.
VVC is more frequent in pregnancy possibly because of higher estrogen levels and higher glycogen content in vaginal secretions; thereby, creating a favorable environment for the yeast to thrive and grow. It is estimated that about 10% of pregnant women in the USA will have a yeast infection at any given time.
Topical clotrimazole and miconazole are the treatment of choice for VVC in pregnancy. They are easily available over the counter and are known to be safe in pregnancy. A recent study has suggested an increased risk of miscarriage by using these azoles.
The researchers from Beer-Sheva, Israel conducted this historical study to investigate the risk of spontaneous abortion after treatment with vaginal antimycotics.
Data was gathered on all clinically apparent pregnancies over a period of 6 years (2003-2009) at the Soroka Medical Center, Clalit Health Services, Beer-Sheva, Israel. Databases with information on medicines dispensed to these patients and information on births and spontaneous abortions were linked together.
Statistical analysis was done by time-varying Cox regression models adjusted for maternal demographics like age, ethnicity, tobacco use, and the year of admission; the presence of chronic diseases like diabetes mellitus, hypothyroidism, obesity, hypercoagulable or inflammatory conditions; and reproductive and contraceptive history.
A total of 65,457 pregnancies were included in the analysis of which 58,949 (90.1%) ended with birth and 6508 (9.9%) with a spontaneous abortion.
Out of which 3246 (5%) pregnancies received vaginal antifungal drugs until the 20th week of gestation: (2712 (4.2%) were exposed to clotrimazole and 633 (1%) to miconazole.
Exposure to vaginal antifungals as a group was not linked to spontaneous abortion (adjusted hazard ratio, 1.11; 95% confidence interval, 0.96–1.29). Individually clotrimazole and miconazole were also not associated with spontaneous abortion.
There was no dose-response relationship observed between the antifungals and spontaneous miscarriages.
The authors concluded that vaginal use of antimycotics is not linked to spontaneous abortion.
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