Are Vaginal Antimycotics Associated with an Increased Risk for Miscarriage?

BACKGROUND AND PURPOSE:

  • Vulvovaginal candidiasis (VVC) may occur in more than 20% of pregnant women
  • A previous study suggested an increased risk of miscarriage after the use of vaginal-antimycotic agents for vulvovaginal candidiasis
  • Daniel et al. (AJOG, 2018) examined whether risk for spontaneous abortions is increased following first-trimester exposure to vaginal antimycotics

METHODS:

  • Population-based retrospective cohort study
  • Participants: All clinically apparent pregnancies admitted for birth or spontaneous abortion
  • A computerized database of medication dispensation was linked with computerized databases containing information on births and spontaneous abortion
  • Time-varying Cox regression models, adjusted for confounding variables such as mother’s age, hypothyroidism, diabetes mellitus, hypercoagulable or inflammatory conditions, recurrent miscarriage, IUD, ethnicity, tobacco use and the year of admission were used to assess the association

RESULTS:

  • 65,457 pregnancies were included in the study
    • 58,949 (90.1%) ended with birth
    • 6,508 (9.9%) ended with spontaneous abortion
  • Overall, 5% of pregnancies were exposed to vaginal antimycotic medications until the 20th gestational week
    • 4.2% were exposed to clotrimazol
    • 1% were exposed to miconazole
  • Exposure to vaginal antimycotics was not associated with spontaneous abortions as a group
    • Crude hazard ratio (HR) 1.11; 95% CI, 0.96–1.29
    • adjusted HR 1.11; 95% CI, 0.96–1.29
  • Clotrimazole was not associated with increased risk
    • adjusted HR 1.05; 95% CI, 0.89–1.25
  • Miconazole was also not associated with increased risk
    • adjusted HR 1.34; 95% CI, 0.99–1.80
  • Dosage did not impact the findings

CONCLUSION:

  • This study found no evidence that taking antimycotics (clotrimazole and miconazole) during the first trimester is associated with increased risk for miscarriage

Learn More – Primary Sources:

Vaginal antimycotics and the risk for spontaneous abortions