Pregnant or yeast infection

Yeast Infections During Pregnancy

With so much going on down there already, the last thing you need is an itchy yeast infection when you’re expecting. Unfortunately, soaring estrogen levels that come with having a bun in the oven increase your risk of having one, making yeast infections the most common vaginal infection during pregnancy. In fact, nearly 75 percent of all adult women have had at least one yeast infection in their lifetime, according to the Centers for Disease Control and Prevention. The good news: While uncomfortable for the mother-to-be, yeast infections don’t affect your pregnancy or your baby-to-be.

What might cause yeast infections

Yeast infections are caused by an overgrowth of an otherwise normal vaginal fungus called Candida albicans. When the balance of bacteria and yeast in the vagina is altered — usually when estrogen levels rise due to pregnancy, oral contraceptive use or estrogen therapy — this yeast may overgrow and cause symptoms. Excess moisture can also exasperate an imbalance, making your nether regions a more welcoming environment for fungal growth.

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Symptoms of yeast infections

It’s normal to experience a significant increase in vaginal discharge during pregnancy: The thin, milky, mild-smelling, voluminous stuff is so common it has a name: leukorrhea. A yeast infection, however, makes your discharge white, lumpy and odorless. You’ll also likely experience itching and burning of the area outside the vagina (called the vulva), which may look red and swollen. Other yeast infection symptoms can include painful urination and discomfort during intercourse.

Complications of yeast infections

Fortunately, yeast infections aren’t dangerous (and they’re rarely more than an irritating inconvenience). But if you have a yeast infection when you go into labor, it is possible to pass it to your baby during delivery, since the fungus that causes vaginal yeast infections can also cause thrush (a yeast imbalance typically in the mouth). In this case, your newborn might develop white patches in the mouth, which can be passed back to you when you breastfeed. Luckily, thrush is easily treated with a mild antifungal medication for baby and an antifungal cream for you.

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One more thing: Yeast infections can look and feel a lot like other more serious conditions, including a variety of sexually transmitted diseases or bacterial vaginosis — one more reason why you shouldn’t ignore your symptoms if you think you have a yeast infection, especially during pregnancy. If you’re experiencing yellow, gray or green discharge with a strong odor or general itching and burning in the vaginal area, let your doctor know.

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How to prevent yeast infections

While you can’t control your hormones (wouldn’t that be nice!), you can take a few steps to prevent yeast infections in the first place, mostly by keeping your genital area dry and allowing air to circulate down there. Some tactics to try:

  • Wear cotton undergarments that allow your genital area to “breathe” (i.e., opt for full-coverage panties over that itty-bitty thong)
  • Sleep sans underwear or pajama bottoms at night to allow the area to breathe
  • Take showers instead of baths (especially bubble baths)
  • Use gentle, unscented soaps on your genitals
  • Never douche or use vaginal sprays or deodorants
  • Practice meticulous hygiene, especially after going to the bathroom (i.e., always wipe from front to back)
  • Don’t sit around in a wet bathing suit
  • After showering or swimming, make sure your genital area is completely dry before putting on your panties and clothes
  • Keep sugar to a minimum in your daily diet (yeast love sugar) as well as refined grain products (which your body converts into sugar)

Despite what you may have heard, there is no clear evidence that yogurt, probiotic products containing live Lactobacillus species, or other natural remedies (like garlic, tea tree oil etc.) are effective for treating or preventing common yeast infections. But since yogurt’s also a good source of calcium, it can’t hurt to add a daily dose to your diet if you’ve had recurrent bouts.

How to treat a yeast infection when you’re pregnant

Even if you’ve had yeast infections before and are a pro at self-diagnosing, it’s best to call your healthcare provider before using an over-the-counter medication. Why? Some women who think they have a yeast infection actually have a bacterial infection like bacterial vaginosis or trichomoniasis, and a yeast infection medication will only prolong the issue. (If it turns out this is the case for you, your doctor may prescribe an antibiotic like clindamycin, or, if you’re in your second or third trimester, metronidazole.)

If you have a yeast infection, you may be able to take an over-the-counter or prescription antifungal cream or vaginal suppository — just be sure to check with your pracitioner first. (For example, the more convenient oral antifungal medication, fluconazole, is not generally recommended for women who are pregnant — some research suggests it could cause birth defects in babies exposed to high doses.) Keep in mind that these treatments may take several days before they bring relief, and that even when you do start to feel better, you should continue to use the medication for as long as your practitioner suggested — which may be a week or more.

Unfortunately, medication may banish a yeast infection only temporarily; the infection often returns off and on until after delivery and may require repeated treatment.

Yeast Infections During Pregnancy: Causes, Symptoms, and Treatment

Yeast infections during pregnancy are more common than any other time in a woman’s life, especially during the second trimester of pregnancy. You may be noticing an increase in the amount of thin, white, odd smelling discharge. This is common and a normal symptom in the second trimester.

If you think you may be experiencing a yeast infection, the following information will prepare you to discuss the possibility with your doctor. Though yeast infections have no major negative effect on pregnancy, they are often more difficult to control during pregnancy, causing significant discomfort for you. Don’t wait to seek treatment!

What is a yeast infection?

Yeast infection occurs when the normal levels of acid and yeast in the vagina are out of balance, which allows the yeast to overgrow causing an uncomfortable, but not serious, a condition called a yeast infection.

If you have never been diagnosed or treated by a physician for a yeast infection and have some of the symptoms, you should see your physician first for accurate diagnosis and treatment. Other infections have similar symptoms, so you want to make sure that you are treating the infection correctly. There are also treatments that are not appropriate during pregnancy.

What causes yeast infections during pregnancy?

A yeast infection can be caused by one or more of the following:

  • Hormonal changes that come with pregnancy or before your period
  • Taking hormones or birth control pills
  • Taking antibiotics or steroids
  • High blood sugar, as in diabetes
  • Vaginal intercourse
  • Douching
  • Blood or semen

Why are yeast infections more common during pregnancy?

Your body is going through so many changes right now, and it is difficult for your body to keep up with the chemical changes in the vagina. There is more sugar in vaginal secretions on which the yeast can feed, causing an imbalance which results in too much yeast.

What are the symptoms of yeast infections?

The symptoms of a yeast infection may include one or more of the following:

  • Discharge that is usually white/tan in color, similar to cottage cheese and may smell like yeast/bread
  • Other discharge may be greenish or yellowish, also similar to cottage cheese and may smell like yeast/bread
  • An increase in discharge
  • Redness, itching, or irritation of the lips of the vagina
  • Burning sensation during urination or intercourse

What else could I be experiencing?

If you are experiencing symptoms similar to a yeast infection, but a physician has ruled this diagnosis out, you may have one of the following:

  • Sexually Transmitted Diseases (STDs) like Chlamydia, Gonorrhea, & Trichomoniasis
  • A vaginal infection called bacterial vaginosis

How do I know for sure if I have a yeast infection?

At your doctor’s office or medical clinic, a clinician will use a simple, painless swab to remove the discharge or vaginal secretions and examine it through a microscope. Usually, upon a simple examination of the vagina, a physician can diagnose a yeast infection. In rare cases, the culture may be sent to a lab.

How are yeast infections treated during pregnancy?

During pregnancy, physicians recommend vaginal creams and suppositories only. The oral medication, Diflucan (a single-dose medication), has not been proven safe during pregnancy and lactation. Not all vaginal creams and suppositories are okay to use during pregnancy, so it is best to consult your doctor or pharmacist to get the right one. If left untreated, yeast infections can pass to your baby’s mouth during delivery. This is called “thrush” and is effectively treated with Nystatin.

It may take 10-14 days to find relief or completely clear up the infection while you are pregnant. After the infection has cleared up and any sores have healed, it may be helpful to use a starch-free drying powder, or Nystatin powder to prevent a recurring infection.

How can I prevent a yeast infection or recurring yeast infections?

Most yeast infections can usually be avoided by doing the following:

  • Wear loose, breathable cotton clothing and cotton underwear.
  • After regular, thorough washing (using unscented, hypoallergenic or gentle soap), use your blow dryer on a low, cool setting to help dry the outside of your genital area.
  • Always wipe from front to back after using the restroom.
  • Shower immediately after you swim. Change out of your swimsuit, workout clothes, or other damp clothes as soon as possible.
  • Do NOT:
    • douche
    • use feminine hygiene sprays
    • use sanitary pads and tampons that contain deodorant
    • take a bubble bath/use scented soaps
    • use colored or perfumed toilet paper
  • Include yogurt with “lactobacillus acidophilus” in your diet.
  • Limit sugar intake, as sugar promotes the growth of yeast.
  • Get plenty of rest to make it easier for your body to fight infections.

When should I contact my doctor?

If you are experiencing the symptoms described in this article, call your doctor now. Yeast infections have similar symptoms of other infections, such as STDs. Proper diagnosis every time you experience these symptoms is vital for the most effective, immediate treatment, or your condition may worsen/not go away.

If you see no improvement within three days, or if symptoms worsen or come back after treatment, you should contact your healthcare provider again.

Last updated: October 9, 2019 at 15:46 pm

Compiled using information from the following sources:

1. American Academy of Family Physicians

1. Mayo Clinic Complete Book of Pregnancy & Babys First Year. Johnson, Robert V., M.D., et al, Ch. 11.

The Food and Drug Administration is investigating whether a medication used for treating yeast infections may pose risks if women take it during pregnancy.

Today, the agency announced that it is reviewing the results of a recent study from Denmark that found a link between the medication, called oral fluconazole (brand name Diflucan) and an increased risk of miscarriages. The study, published Jan. 5 in the Journal of the American Medical Association, found that pregnant women who took oral fluconazole were 48 percent more likely to have a miscarriage than women who didn’t take the drug.

“Until FDA’s review is complete and more is understood about this study … we advise cautious prescribing of oral fluconazole in pregnancy,” the agency said.

Pregnant women are at increased risk for vaginal yeast infections, which are caused by the fungus Candida. It’s thought that changes in hormones during pregnancy — mainly, an increase in levels of estrogen — disrupts the normal pH of the vagina, which may lead to an overgrowth of yeast, according to the Mayo Clinic. About 10 percent of U.S. pregnant women have a yeast infection at any given time, the JAMA study said.

The Centers for Disease Control and Prevention recommends that pregnant women only use topical antifungal medications (often in the form of vaginal suppositories) to treat yeast infections. However, doctors sometimes prescribe oral fluconazole when yeast infections reoccur, or if the symptoms of the infection are particularly severe, according to the JAMA study.

Pregnant women who have a yeast infection should speak with their doctor if they are considering treatments other than topical antifungals, the FDA said.

Follow Rachael Rettner @RachaelRettner. FollowLive Science @livescience, Facebook& Google+. Original article on Live Science.

Vaginal Yeast Infections During Pregnancy

Pregnancy can be a wonderful time for some women and a difficult time for others. So much is going on with your body—between weight changes and hormone fluctuations—the last thing you need is to develop a yeast infection while you’re pregnant! But the fact is, it does happen. Actually, yeast infections are more common during pregnancy compared to any other time in a woman’s life, and tend to happen in the second trimester. They are the result of chemical changes in the vagina and an increase in sugar in vaginal secretions.1 And, yeast feed on sugar!

If you develop a yeast infection during pregnancy, it’s important to understand the importance of choosing the right treatment. Talk to your healthcare professional if you are pregnant and develop a vaginal yeast infection. The CDC and health professionals recommend a 7-day vaginal cream for a yeast infection during pregnancy. The FDA issued a warning about the oral medication fluconazole (Diflucan®) in 20162. Using topical antifungal treatments like MONISTAT® during pregnancy is recommended. Again, talk to your healthcare professional.

Which MONISTAT® Product is Right for You?

MONISTAT® 1

Monistat® 1 Combination Pack is a single-dose product (1200 mg of miconazole nitrate) which may be the perfect solution for busy women with active lifestyles. Available in Ovule® form. Use as directed.

MONISTAT® 3

MONISTAT® 3 is a great treatment option for women who want a less concentrated treatment (200 mg of miconazole nitrate per dose) that provides consistent treatment and relief at moderate dosage levels. Available in Ovule®, cream and suppository forms. Use as directed.

MONISTAT® 7

The MONISTAT® 7 suite of products is the original formula (100 mg of miconazole nitrate per dose), with smaller doses of the active ingredient evenly distributed throughout the week at bedtime. The CDC recommends 7-day treatment for pregnant women and diabetic women (consult a doctor before use). Available in cream form. Use as directed.

All MONISTAT® products relieve yeast infection symptoms 4x faster than the leading prescription pill.

Yeast Infections in Pregnancy: Recommended Treatments

Question

Which treatment options for vaginal yeast infections are safe and effective in the pregnant patient?

Response from Michael Postelnick, BPharm
Lecturer, Department of Medical Education, Northwestern University Feinberg School of Medicine; Senior Infectious Disease Pharmacist, Clinical Manager, Northwestern Memorial Hospital Department of Pharmacy, Chicago, Illinois

Vaginal candidiasis, commonly called “yeast infection,” is relatively common during pregnancy, with an estimated prevalence of 10%-75%. The patient usually presents with vulvar pruritus, burning, soreness, and irritation, with occasional dysuria.

Pregnancy causes increased levels of progesterone and estrogen. Progesterone suppresses the ability of neutrophils to combat Candida, and estrogen disrupts the integrity of vaginal epithelial cells against such pathogens as Candida and decreases immunoglobulins in vaginal secretions. These issues, which continue throughout pregnancy, lend themselves to multiple recurrences of infection.

Treatment is directed at symptom relief. Topical imidazoles are most commonly recommended. Although both miconazole and clotrimazole are available without a prescription, pregnant patients should never self-medicate and should only use these products under the direction of a healthcare provider.

Miconazole is classified by the US Food and Drug Administration (FDA) as pregnancy risk category C; however, the topical vaginal formulation achieves minimal systemic absorption. In clinical trials that included patients in the first trimester, no harm was demonstrated to the mother or fetus.

Clotrimazole vaginal formulations are classified pregnancy risk category B. Studies in the second and third trimesters have not demonstrated adverse outcomes on the mother or fetus. Data are inadequate to categorize risk in the first trimester.

Vaginal candidiasis is more difficult to eradicate during pregnancy, and prolonged durations of treatment ranging from 7 to 14 days are recommended. Multiple formulations and strengths of topical imidazoles are available that affect the duration of therapy for nonpregnant patients; however, during pregnancy, only the dosage forms designed for prolonged-duration therapy should be used.

Appropriate miconazole formulations include the 100-mg vaginal suppository or the 2% vaginal cream applied for a 7-day course of therapy. Clotrimazole 2% vaginal cream should be used for 7 days. Recurrent infections should be treated for 14 days.

Data in pregnancy for other topical antifungal agents are limited, making miconazole and clotrimazole the preferred topical agents in pregnancy.

Given its ease of use and excellent efficacy, oral fluconazole is commonly used for the treatment of vaginal candidiasis in nonpregnant patients. However, use of fluconazole in pregnancy has been controversial.

Animal data suggest that high-dose fluconazole is associated with craniofacial malformations. An analysis of 1079 women from North Denmark who had a live birth or stillbirth after 20 weeks’ gestation found no association between short-term fluconazole use in the first trimester and congenital malformations. However, results from a significantly larger Danish cohort suggested that patients who receive even low doses of fluconazole have a 48% greater risk for spontaneous abortion than those not exposed to fluconazole. Women who received fluconazole had a 62% greater risk for spontaneous abortion than women treated with topical azoles. This study prompted the FDA to issue a safety alert for the prescribing of oral fluconazole during pregnancy.

In summary, treatment of vaginal candidiasis in pregnancy should only be undertaken with guidance from a healthcare provider. Topical imidazoles (miconazole and clotrimazole) have the largest body of evidence regarding safety for both the mother and the fetus during pregnancy. Owing to the physiologic changes that occur during pregnancy that compromise host defenses against Candida, therapy should be continued for a total 7- to 14-day course.

Although fluconazole was previously considered safe in the dosages used to treat vaginal candidiasis, recently published data suggest a significantly higher incidence of miscarriage in patients who receive oral fluconazole for vaginal candidiasis compared with untreated patients and those treated with topical imidazoles. On the basis of these data, it would be prudent to avoid fluconazole during pregnancy if at all possible.

Follow Medscape Pharmacists on Twitter: @MedscapePharm

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