From the Guidelines
During pregnancy, yeast infections can be safely treated with topical antifungal medications, with the first-line treatment being a vaginal azole medication such as clotrimazole or miconazole, used for 7 days. The medications come as creams or suppositories and are available over-the-counter. For application, insert one applicator-full or one suppository into the vagina at bedtime. Oral fluconazole (Diflucan) is generally avoided during pregnancy due to potential risks to the developing fetus, as noted in a study published in 2022 1.
Some key points to consider when treating yeast infections during pregnancy include:
- The use of topical azole therapies, such as butoconazole, clotrimazole, miconazole, and terconazole, as recommended by the Centers for Disease Control and Prevention in 1998 1 and 2002 1.
- The importance of avoiding oral fluconazole during pregnancy, as it has been associated with spontaneous abortion and other risks, as highlighted in a 2022 review of the evidence for the 2021 Centers for Disease Control and Prevention of sexually transmitted infections treatment guidelines 1.
- The need for pregnant women to be aware of the potential risks and benefits of different treatment options, and to consult their healthcare provider if symptoms persist or recur frequently.
To help prevent recurrence, it is recommended to:
- Wear cotton underwear
- Avoid tight clothing
- Minimize sugar intake
- Promptly change out of wet clothing like swimsuits Yeast infections are common during pregnancy because hormonal changes create a more favorable environment for yeast growth. The higher estrogen levels increase glycogen in the vagina, providing more food for yeast, while pregnancy's suppressed immune system makes it harder to fight off infections. If symptoms persist after treatment or recur frequently, consult your healthcare provider as persistent infections may sometimes require longer courses of treatment, as suggested by a study published in 2022 1.
From the FDA Drug Label
Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. In both, the results of the fluconazole regimen were comparable to the control regimen (clotrimazole or miconazole intravaginally for 7 days) both clinically and statistically at the one month post-treatment evaluation The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group
The treatment for yeast infection in pregnancy is not explicitly mentioned in the provided drug labels. However, fluconazole and clotrimazole are mentioned as treatments for vaginal candidiasis.
- Fluconazole is an oral medication with a therapeutic cure rate of 55% for vaginal candidiasis.
- Clotrimazole is a topical treatment that relieves external itching and irritation due to a vaginal yeast infection. It is essential to consult a healthcare professional for proper diagnosis and treatment, especially during pregnancy, as the safety and efficacy of these medications may vary in this population 2, 2, 3.
From the Research
Treatment Options for Yeast Infections During Pregnancy
- Topical azole antifungals are recommended for the treatment of yeast infections during pregnancy, with a treatment duration of at least 7 days 4.
- Nystatin is considered safe for vaginal therapy and is minimally absorbed, making it a viable option for pregnant women 5.
- Imidazoles, such as clotrimazole and miconazole, are effective for vaginal yeast infections and can be used during pregnancy, although their systemic absorption is higher than when applied to the skin 5.
- Fluconazole can be used during pregnancy, but it is recommended to use a lower dose (150 mg/day) to minimize the risk of teratogenic effects 5, 6.
Safety of Antifungal Medications During Pregnancy
- Existing data indicate that exposure to oral and topical antifungals during pregnancy is not associated with an increased risk of major malformations 4.
- Ketoconazole, flucytosine, and griseofulvin have been shown to be teratogenic and/or embryotoxic in animals and should be avoided during pregnancy 5.
- Iodides have been associated with congenital goiter and should not be used during pregnancy 5.
- Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy, according to expert consensus 7.
Comparison of Treatment Options
- A comparison of nystatin, clotrimazole, and miconazole found that all three were effective in curing vaginal candidiasis, but miconazole had a lower relapse rate 8.
- A comparative study of fluconazole and clotrimazole found that both were effective in treating vulvovaginal candidiasis, with similar mycological cure rates and minimal side effects 6.