Use of antimycotics in early pregnancy is not linked to spontaneous abortion

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 20^th 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.

Abstract

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Caution in using oral fluconazole during pregnancy

Vulvo vaginal candidiasis (VVC) usually is caused by C. albicans but can occasionally be caused by other Candida sp. or yeasts as C. glabrata, C. tropicalis, C. krusei and C. parapsilosis.

Vaginal candidiasis is common during pregnancy.

According to Center for Disease control (CDC) an estimated 10-15% of women will have one episodes of Vaginal candidiasis  in pregnancy.

According to CDC 2015 Sexually Transmitted Diseases Treatment Guidelines only topical azole therapies, applied for 7 days, are recommended for use among pregnant women.

But, in cases of recurrence or severe symptoms or when topical treatment has failed oral fluconazole is often used despite of limited safety information available.

According to a recent study published in Journal of American Medical Association (JAMA) on January 5, 2016, a link is found between the use of oral Fluconozole in pregnancy and the risk of spontaneous abortion or still birth down the lane.

This is a nation wide register based cohort study by Danish researcher spanning 17 years and studying 1,405,663 pregnancies.

The pregnancies were matched on other confounding factors!

Of 3315 women who took oral fluconazole during the 7th through 22nd weeks of gestation, 147 had a spontaneous abortion. In contrast, of 13,246 matched controls (pregnant women with no fluconazole exposure), 563 had spontaneous abortions, a difference that translated into a hazard ratio (HR) of 1.48.

An increasing trend towards stillbirth was also seen in women who took oral fluconazole, when comparing with unexposed matched controls or unexposed unmatched pregnant women, but these differences were not statistically significant, reported the researcher from   the Department of Epidemiology Research at Statens Serum Institut in Copenhagen, Denmark.

A higher association was noted as the dose increased from the routine dose of 150 milligrams.

So it means that scientists concluded that women in this Danish study who used the drug during the first six months of pregnancy were almost 50 percent more likely than nonusers to have a miscarriage.

While this study does not establish a cause- effect relationship, but it does warrant larger studies, more research and a caution to physician and patient about the use of oral fluconozole in pregnancy.

Dr Scott Sullivan, a member of the ethics committee at the American Congress of Obstetricians and Gynecologists, said the new study doesn't prove any miscarriage risk from fluconazole, 'it just means we need more data, more studies'.

The researcher also urged patients in being caution taking fluconozole while pregnant as it is freely available over the counter.

References:

http://www.sciencemediacentre.org/expert-reaction-to-study-investigating-oral-medication-for-thrush-in-pregnancy-and-risk-of-miscarriage/

http://www.bmj.com/content/352/bmj.h7029.short?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Frecent+%28Latest+from+BMJ%29

http://www.wallstreethedge.com/popular-yeast-infection-pill-heightens-miscarriage-risk/28271/

http://www.medscape.com/viewarticle/856792

http://jama.jamanetwork.com/article.aspx?articleid=2480487#References

http://www.cdc.gov/std/tg2015/candidiasis.htm