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Vaginal miconazole and clotrimazole show no additional risk of spontaneous abortion

July 24 2018

The prevalence of vulvovaginal candidiasis (VVC) among pregnant women may be around 20-25%, with around 7% being prescribed antifungals during the first trimester. However, previous small-scale studies have suggested a link between azole antifungals and spontaneous abortion (but generally not stillbirth).

Dr Sharon Daniel and colleagues in Israel recently conducted a retrospective cohort study of 65,457 clinically apparent pregnancies at the Maternity Unit of a regional hospital. No association was seen between spontaneous abortion and either vaginal clotrimazole or vaginal miconazole, even for repeated treatment cycles.

However, a Danish group have previously reported that fluconazole carries a greater risk of spontaneous abortion and stillbirth, as well as Tetralogy of Fallot.

Likelihood of spontaneous abortion among pregnant women treated with azole antifungals, versus those not exposed to antifungals.

N numbers indicate the number of exposed pregnancies. Ratio (black diamond) and 95% confidence intervals (grey dashes). A confidence interval ratio spanning 1 (horizontal grey line) indicates that the treated group is not significantly different from untreated controls. Data taken from Daniel et al (2018), Rosa et al (1987) and Mølgaard-Nielsen et al (2016).