Can vaginal candidiasis cause preterm contractions?

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Vaginal Candidiasis and Preterm Contractions

While there is some evidence suggesting an association between vulvovaginal candidiasis (VVC) during pregnancy and preterm contractions, the evidence is not as strong as for other vaginal infections like bacterial vaginosis or trichomoniasis.

Association Between Vaginal Candidiasis and Preterm Birth

Current Evidence

  • Several studies with methodological limitations have demonstrated an association between VVC and preterm delivery 1
  • Recent evidence suggests a possible association between VVC and adverse obstetric outcomes, including premature rupture of membranes, chorioamnionitis, and preterm birth 2
  • A systematic review and meta-analysis found that treatment of asymptomatic vaginal candidiasis may reduce the risk of spontaneous preterm birth (meta-analysis RR = 0.36,95% CI = 0.17 to 0.75) 3
  • A pilot study showed a tendency toward reduction in spontaneous preterm birth among women with asymptomatic candidiasis who were treated with clotrimazole (RR = 0.33,95% CI 0.04-3.03) 4

Strength of Evidence

  • The CDC and ACOG guidelines do not explicitly list VVC as a strong risk factor for preterm birth, unlike bacterial vaginosis and trichomoniasis 1
  • Most of the evidence comes from smaller studies or post-hoc analyses, with methodological limitations 3
  • The relationship between VVC and preterm birth requires further investigation with higher quality studies 1

Comparison with Other Vaginal Infections

Bacterial Vaginosis

  • Bacterial vaginosis has been more consistently associated with premature rupture of membranes, preterm labor, preterm birth, and postpartum endometritis 1
  • ACOG notes that bacterial vaginosis has been associated with preterm delivery independent of other known risk factors 1

Trichomoniasis

  • Vaginal trichomoniasis has been associated with adverse pregnancy outcomes, particularly premature rupture of membranes, preterm delivery, and low birth weight 1

Management Considerations

Screening and Treatment

  • Current guidelines do not recommend routine screening for asymptomatic VVC in pregnancy 5
  • For symptomatic VVC during pregnancy, only topical azole therapy is recommended 1
  • The preferred treatment for VVC in pregnancy is a 7-day course of topical azole medications 5
  • Oral fluconazole should be avoided during pregnancy due to potential risks including spontaneous abortion 1

Clinical Approach

  • For pregnant women with symptomatic VVC:
    1. Confirm diagnosis with wet mount or culture
    2. Treat with topical azole for 7 days
    3. Consider follow-up one month after treatment completion if there are concerns about pregnancy outcomes 1
    4. Avoid oral antifungals during pregnancy 5

Future Research Needs

  • Additional higher-quality studies are needed to further investigate the relationship between VVC and preterm birth 1
  • A large, adequately powered randomized trial of clotrimazole to prevent preterm birth in women with asymptomatic candidiasis appears warranted 4

Key Takeaway

While there is some emerging evidence suggesting an association between VVC and preterm birth, the evidence is not as robust as for other vaginal infections. Treatment of symptomatic VVC in pregnancy is recommended using topical azoles, but routine screening and treatment of asymptomatic VVC specifically to prevent preterm birth is not currently recommended in clinical guidelines.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

Vulvovaginal Candidiasis Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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