What should I do if I develop vulvovaginal candidiasis (yeast infection) during pregnancy?

Vulvovaginal candidiasis (VVC), also known as candidal vaginitis or vulvovaginal candidiasis, is a common and frequently occurring inflammatory condition of the vulva and vagina caused by Candida species. Candida albicans, an opportunistic pathogen, colonizes the vaginal tract in 10–20% of non-pregnant women and up to 30% of pregnant women; however, colonization at low levels typically remains asymptomatic. So, what should be done if a woman develops vulvovaginal candidiasis during pregnancy? The following addresses this question.

What to do if vulvovaginal candidiasis occurs during pregnancy

Vulvovaginal candidiasis is an inflammatory condition of the vulva and vagina caused by infection with Candida (primarily C. albicans). It is predominantly endogenous in origin—arising from overgrowth of opportunistic fungi normally present in the vaginal flora—with only a small proportion of cases resulting from indirect transmission via contaminated clothing or personal items. Diagnosis requires microscopic identification of budding yeast cells or pseudohyphae in vaginal secretions.

Management involves eliminating predisposing factors: discontinuing broad-spectrum antibiotics and estrogen-containing medications, treating underlying conditions such as diabetes mellitus, changing underwear frequently, and boiling used towels and other personal items for disinfection. Local antifungal therapy is preferred, ideally using low-dose, extended-duration regimens. Topical azole antifungals (e.g., vaginal suppositories or creams) are recommended; oral azole antifungals are contraindicated during pregnancy.

Does vaginitis during pregnancy affect the fetus?

Whether vaginitis during pregnancy affects the fetus depends on the specific type of vaginitis. For example, trichomonas vaginitis in pregnancy has been associated with adverse obstetric outcomes, including preterm premature rupture of membranes (PPROM), preterm birth, and low birth weight. The primary goals of management during pregnancy are symptom relief and prevention of complications.

Currently, evidence remains inconclusive regarding whether metronidazole treatment improves adverse pregnancy outcomes in trichomonas vaginitis. Bacterial vaginosis during pregnancy is associated with several adverse outcomes, including chorioamnionitis, PPROM, preterm delivery, and postpartum endometritis. Therefore, all symptomatic pregnant women diagnosed with bacterial vaginosis should receive appropriate treatment.

The above outlines key considerations for managing vulvovaginal candidiasis during pregnancy. We hope this information is helpful to you.