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  • Association of Topical Prostaglandins With Miscarriages

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, June 2022

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    Do topical prostaglandin analogues (PGAs) increase the risk of miscarriage in pregnant patients with glaucoma? Etminan et al. examined this hypoth­esis and found no association between PGA use and spontaneous abortions.

    For this case-series study, the researchers used the PharMetrics Plus database for health claims in the United States from 2006 to 2020. They quan­tified the percentage of spontaneous abortions among patients who took a topical PGA and a control cohort of women in the database who did not take a PGA. All participants were be­tween 15 and 45 years of age. The main outcome was billing codes for diagnosis and treatment of spontaneous abortion.

    All told, the researchers identified 3,881 women of reproductive age who were prescribed a PGA. Of these, 261 were pregnant, and 26 had a sponta­neous abortion code. In comparison, of the 3,881 women in the control group, 801 were pregnant, and 56 were identi­fied as having experienced a spontaneous abortion. The researchers noted that both groups were compara­ble with respect to age, mood disorders, preeclampsia, and the use of drugs associated with spontaneous abortion (e.g., antiepileptics, selective serotonin reuptake inhibitors, and serotonin antagonists).

    In their discussion, the authors noted that pharmacologic data indi­cate that oral PGAs may cause uterine contraction—and that systemic absorp­tion has been reported with topical PGAs. In addition, they point out that topical PGAs are currently classified as pregnancy category C (teratogenic in animals), although the doses used in the relevant animal studies were up to 80 times higher than those used in humans.

    Although the results of their study indicate no association between PGA use and the risk of spontaneous abor­tion, the authors recommend further exploration of the topic in epidemio­logic studies that can better control for potential confounding variables. (Also see related commentary by Thasarat Sutabutr Jajaranant, MD, MHA, in the same issue.)

    The original article can be found here.