What is the recommended treatment for yeast infections during pregnancy?

From the Guidelines

Fluconazole is not recommended for yeast infections during pregnancy due to potential risks to the fetus, and topical azole antifungals such as clotrimazole and miconazole are preferred. The treatment of yeast infections during pregnancy is crucial to prevent complications and ensure the health of both the mother and the fetus. According to the most recent and highest quality study 1, fluconazole use during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects.

Treatment Options

• Topical azole antifungals, such as clotrimazole and miconazole, are the first-line treatment options for yeast infections during pregnancy.
• These medications are available as vaginal creams or suppositories and are generally used for 7 days.
• For example, clotrimazole 1% cream can be applied intravaginally at bedtime for 7 nights, or miconazole 2% cream can be used similarly.
• These topical treatments are preferred during pregnancy because they have minimal systemic absorption, making them safer for the developing fetus.

Prevention of Recurrence

• Pregnant women should wear cotton underwear, avoid tight clothing, wipe from front to back after using the bathroom, and avoid douching or using scented products in the genital area to prevent recurrence of yeast infections.
• Symptoms should improve within a few days of starting treatment, but the full course should be completed even if symptoms resolve early.
• For recurrent infections, longer courses of topical treatment may be needed, as stated in earlier guidelines 1.
• It is essential to note that while older studies 1 provide valuable information on the treatment of yeast infections during pregnancy, the most recent study 1 offers the most up-to-date guidance on the potential risks associated with fluconazole use during pregnancy.

Key Considerations

• The use of fluconazole during pregnancy is generally avoided, especially in the first trimester, due to potential risks to the fetus, as highlighted in the study 1.
• Current guidelines state that only topical azole therapy should be used to treat yeast infections in pregnancy, as mentioned in the study 1.
• Additional higher quality studies are needed to further investigate the relationship between yeast infections and preterm delivery, as noted in the study 1.

From the FDA Drug Label

The convenience and efficacy of the single dose oral tablet of fluconazole regimen for the treatment of vaginal yeast infections should be weighed against the acceptability of a higher incidence of drug related adverse events with fluconazole (26%) versus intravaginal agents (16%) in U.S. comparative clinical studies.

Fluconazole is not recommended as a first-line treatment for yeast infections during pregnancy. The FDA drug label does not provide direct information on the safety of fluconazole for yeast infections during pregnancy, and its use should be cautiously considered due to potential risks. Alternative treatments, such as intravaginal agents like clotrimazole, may be preferred. 2

From the Research

Treatment Options for Yeast Infections During Pregnancy

• The recommended treatment for yeast infections during pregnancy is typically topical azoles, as they are considered safe for use during pregnancy 3.
• Oral fluconazole is not recommended during pregnancy due to potential risks, including an increased risk of spontaneous abortion and congenital malformations 4, 5.
• Boric acid is an alternative treatment option for recurrent vulvovaginal candidiasis, particularly for cases caused by non-albicans Candida species or azole-resistant strains 6.
• Vaginal nystatin suppositories are also an effective treatment option for recurrent vulvovaginal candidiasis, including cases caused by fluconazole-resistant Candida 7.

Safety of Fluconazole During Pregnancy

• Studies have shown that oral fluconazole use during the first trimester of pregnancy may be associated with an increased risk of spontaneous abortion and congenital malformations, particularly heart malformations 4, 5.
• High-dose fluconazole (>150 mg) during the first trimester may increase the risk of cardiac septal closure anomalies 4.
• The use of fluconazole during pregnancy should be avoided, especially during the first trimester, due to the potential risks to the fetus 3, 4, 5.

Alternative Treatment Options

• Topical azoles, such as clotrimazole, miconazole, and terconazole, are considered safe and effective treatment options for yeast infections during pregnancy 3.
• Boric acid and vaginal nystatin suppositories are alternative treatment options for recurrent vulvovaginal candidiasis, particularly for cases caused by non-albicans Candida species or azole-resistant strains 6, 7.