Prostaglandin Analogue Use Not Associated with Risk of Spontaneous Abortion

Mahyar Etminan, PharmD, MSc

An association between the use of topical prostaglandin analogues (PGAs) for intraocular pressure control and the risk of spontaneous abortions was not observed in the findings of a recent case-series study.

Despite recent reports of increased risk with the use of PGA and risk of spontaneous abortion in reporting databases in the United States and Japan, investigators in the current study noted these databases are open to reporting bias and analyses often cannot control for confounding factors.

“Topical PGAs might be preferred for intraocular pressure control over other glaucoma drops because of possibly greater efficacy, and they may be given to people during pregnancy,” wrote study author Mahyar Etminan, PharmD, MSc, Faculty of Medicine, University of British Columbia.

Previous research has reported topical PGAs to have systemic effects from absorption and pharmacologic data indicate PGAs can lead to uterus contraction. Within the current study, they hypothesized that the use of topic PGAs is not associated with an increased risk of spontaneous abortion.

The included data source was the PharMetrics Plus database (IQVIA) for health claims in the United States from 2006 - 2020, containing health information for more than 150 million patients. A diagnosis of a spontaneous abortion was determined through procedures codes or codes from the International Classification of Diseases, Ninth Revision, or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-9/10]).

Investigators quantified the percentage of spontaneous aboriton among patients aged 15 to 45 years who were pregnant and took a topical PGA medication in this period, compared with a random sample of individuals who were not taking a PGA agent.

They excluded all patients who had prior ICD-9/10 codes for smoking or drug and alcohol dependence.

A total of 3881 people prescribed PGAs and 3681 control participants not taking PGAs were identified as the population for the study. Of those in the PGA cohort, a total of 261 were pregnant and 26 had a spontaneous abortion code.

From the 26 individuals, 12 (4.5%) had a spontaneous abortion code within 90 days of the pregnancy code and had an overlapping prescription for a PGA. Of the 12 individuals, 5 (41.7%) were in the age category 40 to 45 years.

Within the control group, there were 801 pregnancies (746 in people aged <40 years, 55 in those aged ≥40 years). In this cohort, 56 spontaneous aboritions (7%) were identified, resulting in an increased risk of 2.4% (95% CI, -0.7% to 5.4%; P = .17).

“Given the nature of this study design and potential for unmeasured confounding factors, these results might be explored further in future epidemiologic studies that can better control for potential confounding variables and more accurately ascertain spontaneous abortions through perinatal databases,” concluded Ethminan. 

The study, “Association of Topical Prostaglandin Analogue Use With Risk of Spontaneous Abortion,” was published in JAMA Ophthalmology.