Robyn Horsager-Boehrer, M.D.
Obstetrics and Gynecology
Vaginal candidiasis, also known as a yeast infection, can be a real pain. The itching, burning, and discharge can be especially worrisome during pregnancy.
In most cases, though, vaginal yeast infections and most treatment options pose minimal risk to the patient or pregnancy.
After bacterial vaginal infections, yeast infections are the second most common cause of vaginal inflammation, and 75% of women will have at least one in their lifetime. Common symptoms can include redness, itching, or irritation on the external genital area (vulva), an increase in white or tan vaginal discharge, and a burning sensation during urination or intercourse.
There are a range of over-the-counter and prescription treatments, and an Ob/Gyn or gynecologist can help you choose the safest, most effective option during pregnancy.
I’ve invited Meredith McClure, M.D., a UT Southwestern gynecologist, to answer the top questions pregnant and breastfeeding patients ask about yeast infection treatment and prevention.
Q: How common are yeast infections during pregnancy?
A: Studies have found that 20%-30% of women develop a yeast infection during pregnancy. An increase in the hormone estrogen creates a more hospitable climate for yeast to colonize the vagina because it binds to the protein factor H on the surface of the cells that cause vulvovaginal candidiasis.
Some women are more likely to develop yeast infections due to their genetics. Mutations of several genes can interfere with the immune system’s ability to defend against candida yeast, resulting in recurring infections for some people. This inherited predisposition is called familial candidiasis.
Q: Can a yeast infection harm my pregnancy?
A: No. A yeast infection won’t affect your developing baby – that’s why we don’t treat yeast infections that don’t have symptoms. However, most symptomatic yeast infections get worse when left untreated. This means more itching, redness, and inflammation. If the skin becomes cracked or torn from repeated scratching, a skin infection can result. In rare cases, an untreated yeast infection can lead to fatigue, oral thrush, or digestive problems.
Q: Do yeast infections appear throughout pregnancy?
A: Yeast infections can occur any time, but they are most common during the second trimester. Talk with your doctor if you notice signs of a yeast infection while pregnant, even if you have had one before. Some more serious infections have similar symptoms, so your doctor will perform a simple fungal culture swap in the office to check for the presence of yeast.
Q: What treatment options are available?
A: Topical creams or vaginal suppositories are the recommended yeast infection treatment options during pregnancy or while breastfeeding. Over-the-counter medications such as Miconazole, Clotrimazole, and Terconazole have been shown to eliminate a yeast infection safely and effectively. They are usually applied for three to seven days. It is important to finish the entire course of medication to prevent the infection from coming back. Studies have demonstrated these medications are safe to use during pregnancy.
The oral medication Diflucan (fluconazole) is not recommended for most patients during pregnancy. Though taking a single pill is simpler, quicker, and less messy, some studies suggest fluconazole carries a slightly increased risk of miscarriage, birth defects, or stillbirth, especially at high doses taken over long periods of time.
While the increase is small – approximately 12 incidents per 10,000 births – the convenience of single-pill treatment might not outweigh the risk. However, in the event you have already taken or need to take fluconazole while pregnant, the additional risk at a normal dose is unlikely to pose any problems for your baby.
Q: Are yeast infection treatments safe while breastfeeding?
A: Yeast infections are less common among breastfeeding patients because estrogen levels drop dramatically in the postpartum period, making it hard for yeast to thrive. But if they occur, fluconazole may be taken by women who are breastfeeding as the levels secreted into breast milk are small.
It is possible for a breastfeeding mother and baby to pass thrush, a fungal infection that typically grows in the mouth and throat, back and forth between nipple and mouth. If that happens, both must be treated to stop the infection. Thrush is usually minor and is often caused by the same fungus – and treated with a 7- to 14-day course of the same antifungal medicines – as a yeast infection in the vagina.
Q: What steps can reduce the risk of yeast infection?
A: During pregnancy and otherwise, take the following precautions:
- Wipe front to back after using the toilet.
- Avoid using scented tampons, pads, and pantyliners.
- Change tampons, pads, and pantyliners often.
- Avoid very hot baths and hot tubs.
- Wear underwear with a cotton lining to promote airflow.
- Do not douche, which removes healthy vaginal bacteria that prevent infection.
- Wear loose fitting clothing.
- Manage your blood sugar if you have diabetes or gestational diabetes.
- Remove wet workout clothes and swimsuits as soon as possible after activities.
If you’re pregnant and notice signs of a yeast infection, discuss treatment options with your doctor so you can eliminate these disruptive symptoms. To request an appointment, call 214-645-8300 or request online.
