Prevalence and Risk factors of Vulvovaginal Candidiasis during pregnancy: A review

Abstract

Vulvovaginal candidiasis (VVC) is an infection of the vagina caused by yeast, especially Candida spp. Although VVC is common among reproductive-age women, prevalence studies notice its uprise to 30% during pregnancy, especially in the last trimester. Recent studies have considered it a severe problem due to the emerging evidence showing the association of VVC with a higher risk of pregnancy-related complications (e.g., premature rupture of membranes, preterm labor, chorioamnionitis, and congenital cutaneous candidiasis). In this review, we have reassessed and summarized the prevalence of VVC in pregnant women and analyzed the association of several factors to the increased risk of VVC during pregnancy in different regions of the world. Data collected from various studies showed the highest prevalence of VVC during pregnancy, mostly in Asian and African countries (90.38%, 62.2%, 61.5% in Kenya, Nigeria, and Yemen, respectively). The prevalence rate of VVC during pregnancy was also found out to differ with age, gestation period, parity, educational status, and socioeconomic level. In the majority of the cases, women in their 3rd trimester showed the highest prevalence of VVC, and the rate of Candida colonization was also higher in pregnant women with no primary education. Multi-gravidae mothers and women with multipara of parity were found to show the highest prevalence of VVC in most cases. Candida albicans was identified as the responsible organism for VVC in most studies, yet a remarkable increase in the incidence rate of non-albicans Candida spp. particularly Candida glabrata, Candida krusei, Candida tropicalis as the causative agent of VVC during pregnancy had been noticed in other studies. Some pregnancy-related factors (e.g., weakened immunity; elevated level of sex hormones, glycogen deposition; low vaginal pH; decreased cellmediated immunity) and several clinical and behavioral factors were suggested as potential risk factors of candidiasis during pregnancy. In our analysis, we couldn’t find any difference in 6 prevalence between symptomatic and asymptomatic VVC cases. While some literature found a higher expression of symptomatic VVC among pregnant women, others found out asymptomatic VVC at greater rates. Furthermore, in our analysis, no definitive association could be established between the prevalence of VVC and factors such as Diabetes mellitus, HIV infection, previous candidiasis, use of antibiotics, oral contraceptives, and intrauterine device despite of the fact that some authors found an association between them.