From the Research
Asymptomatic vaginal candidiasis in pregnancy does not require treatment, as it is not associated with an increased risk of preterm birth or other adverse pregnancy outcomes, according to the most recent and highest quality study 1.
Rationale for Not Treating Asymptomatic Colonization
The rationale for not treating asymptomatic colonization is that candida can be part of normal vaginal flora in many women, and unnecessary treatment may disrupt the vaginal microbiome and potentially contribute to antifungal resistance without providing clinical benefit.
Treatment of Symptomatic Candidiasis
If a pregnant woman develops symptoms of candidiasis, such as itching, burning, or abnormal discharge, treatment is appropriate. For symptomatic candidiasis in pregnancy, topical azole medications are the first-line treatment, with options including clotrimazole, miconazole, or terconazole vaginal creams or suppositories for 7 days 2.
Key Points to Consider
- Asymptomatic vaginal candidiasis is common in pregnancy and is not associated with an increased risk of preterm birth or other adverse pregnancy outcomes 1.
- Treatment of asymptomatic vaginal candidiasis is not recommended, as it may disrupt the vaginal microbiome and contribute to antifungal resistance without providing clinical benefit.
- Symptomatic candidiasis in pregnancy should be treated with topical azole medications, such as clotrimazole, miconazole, or terconazole, for 7 days 2.
- Oral fluconazole is generally avoided in pregnancy due to potential risks, particularly in the first trimester.
- The American College of Obstetricians and Gynecologists (ACOG) guidelines do not recommend screening for or treating asymptomatic candida colonization during pregnancy, as it does not reduce the risk of preterm birth or other adverse pregnancy outcomes.