Yeast Infections During Pregnancy

by David Eschenbach, MD, William Ledger, MD, FACOG and Benson Horowitz, MD

Yeast infections are a common problem for women and some say pregnancy increases your risk. Many women feel they know enough about the condition to take care of it themselves, but for pregnant women, self-diagnosis is a no-no. Tune in as experts discuss why pregnant women are considered more prone to yeast infections and why a doctor's visit is a must.

Yeast infections are a common problem for women, and many think they know enough about the condition to treat it themselves. But most doctors agree that self-diagnosis isn't always a good idea. And for pregnant's out of the question.

BENSON HOROWITZ, MD: Pregnant women should never self-treat. We worry about drugs in pregnancy, and no drug of any kind, topical or otherwise, should be taken by a pregnant woman without the consent of her provider.

DAVID ESCHENBACH, MD: We're naturally cautious about pregnant women and the medication we give them, just simply because not only do we have an adult but we got a developing fetus here to be concerned about.

ANNOUNCER: some experts think yeast infections are more common during pregnancy, making the condition an important factor in prenatal care.

DAVID ESCHENBACH, MD: What people often ask is why are yeast infections more common in pregnancy and the simple answer: We don't know. But we think pregnancy has an impact on reducing the immune system to the point where it allows the organism to grow and cause symptoms more readily.

ANNOUNCER: Others believe that pregnancy does not increase the risk of infection, but still stress that pregnant women who are infected should approach treatment with caution.

WILLIAM LEDGER, MD, FACOG: I think that the risk of the individual woman getting a yeast infection is probably based upon her local immune system and how it works. And if she is a woman that has a pretty good immune system against yeast, it probably doesn't matter whether she's pregnant or not or whether she takes antibiotics, she's not going to have a problem.

The concerns of the treatment of a yeast infection in a pregnant woman and a non-pregnant woman are much different except for the fetus. I think that you don't want to give anything to the pregnant woman that might be a problem for the fetus.

ANNOUNCER: Diflucan, an oral medication that is absorbed through the bloodstream, is one drug that may pose a risk to the fetus.

WILLIAM LEDGER, MD, FACOG: Diflucan is an excellent oral drug against vaginal yeast infections, but I don't think it should be used in pregnant women. I think there are some case reports that suggest that there could be problems with it for the baby. I don't think it's ever been confirmed by large studies, but I think there's enough concern that I don't like to use it during pregnancy.

DAVID ESCHENBACH, MD: Diflucan could possibly cause some teratogenic issues with the baby, it could possibly affect the mother's liver. And although it's been used a lot, we're more concerned about the safety of that drug than we are with the other preparations that are used vaginally.

ANNOUNCER: Vaginal treatments are topical drugs, which are applied directly to the site of infection. That means the active chemicals may be less likely to put the fetus in danger.

WILLIAM LEDGER, MD, FACOG: You have Monistat and Terazol, Gyne-Lotrimin, and the old Mycostatin or nystatin vaginal tablets, which are, I think are all effective, among others.

ANNOUNCER: In fact, the only concern with topical medications is that some of them may pose a risk to the fetus in the first trimester. So some doctors prefer to use milder treatments until later in the pregnancy.

BENSON HOROWITZ, MD: A yeast infection early in the pregnancy is a problem. We only have several treatments for that. We can use gentian violet early in a pregnancy safely, and we can use Mycostatin early in a pregnancy. However, Mycostatin is a very old drug and does not have a very high success rate.

ANNOUNCER: At any time in the pregnancy, treatment should be completed as quickly as possible, to reduce the risk of exposure to the fetus, however small it may be.

BENSON HOROWITZ, MD: In pregnant women, the shorter possible treatment schedules are better, because we don't want to subject the fetus to any more drug than we have to, so we look to a very short treatment schedule, just enough to get rid of it.

WILLIAM LEDGER, MD, FACOG: I'm fairly comfortable with the three-day treatment. I think that it usually works. There are very few women that have reactions to it, and I think that it's well tolerated. The one-day treatment is wonderful for the woman. I mean, it's one dose, and she has it over with, but I've had a number of women that have had reactions to that, which I think is related maybe to the concentration of the medication.

ANNOUNCER: Women should know, however, that their condition is likely to recur during the pregnancy, and if it's present during childbirth, the infection may be transmitted to the newborn.

BENSON HOROWITZ, MD: The neonate can get thrush in the oral cavity, which is fairly obvious. You see white patches on the tongue of the newborn, and that looks like a yeast infection. It becomes more problematic when you think the baby has a diaper rash, and your pediatrician starts treating it for a diaper rash, and you find out it has to be treated with an antifungal cream.

ANNOUNCER: It's up to your doctor to watch out for these infections after your baby is born, so it's important to speak up about your problem. And if it turns out to be something other than a yeast infection, your doctor can help you avoid unnecessary treatments.

WILLIAM LEDGER, MD, FACOG: There is an assumption that almost any vaginal infection during pregnancy is a yeast infection, and that's not true. So I think it's very, very important that pregnant women get evaluated to determine what kind of infection they're having, or whether this is just simply increased secretions due to the pregnancy.

ANNOUNCER: So if you're pregnant and are experiencing vaginal irritation, talk to your doctor right away, even if you you've had yeast infections before. Because it's not just your health that's at stake.