The colonization with Candida species is more harmful in the second trimester of pregnancy

Iris Holzer,Alex Farr,Ljubomir Petricevic,Michael Hagmann,Herbert Kiss

doi:10.1007/s00404-017-4331-y

Abstract

PurposeVaginal colonization with Candida species (spp.) during pregnancy has been associated with impaired pregnancy outcomes. There is a reduction in spontaneous preterm birth among women with recurrent asymptomatic colonization of Candida who were treated with clotrimazole. This study aimed to evaluate the impact of the trimester of vulvovaginal colonization with Candida species.MethodsData from all women, who were tested positive for the vaginal colonization with Candida spp. during the first or second trimester of pregnancy, and who registered for a planned birth at our tertiary referral center between 2005 and 2014 were retrospectively analyzed. Their preterm birth rate served as the primary outcome variable. Secondary outcome variables were neonatal birthweight and Apgar score.ResultsOverall, 1066 women were eligible for the study. In 673 women (63%), who were diagnosed with Candida spp. during the first trimester of pregnancy, the rate of preterm birth was 10% (N = 64). In 393 women (37%), who were diagnosed with candidosis during the second trimester, the preterm birth rate was 18% (N = 71; p = 0.0002). Neonates of women, who presented with vulvovaginal candidosis during the first trimester, had a mean birthweight of 3243 g, compared to 2989 g in the group with a second trimester colonization (p < 0.0001).ConclusionWomen who are colonized with Candida spp. during the second trimester of pregnancy have higher rates of preterm birth and lower neonatal birthweight than those who are colonized during the first trimester of their pregnancy. Screening programs for asymptomatic Candida colonization should take this information into account.

Highlights

Preterm birth (PTB) is defined as birth before 37 completed gestational weeks
Women who are colonized with Candida spp. during the second trimester of pregnancy have higher rates of preterm birth and lower neonatal birthweight than those who are colonized during the first trimester of their pregnancy
Pregnancy outcomes were assessed on the basis of gestational age at Retrospective data analysis identified a total of 1066 women with singleton pregnancies, who were antenatally, and for the first time, diagnosed with asymptomatic and/ or symptomatic Candida spp. on the basis of their vaginal smears, during the first or second trimester of their pregnancy

Summary

Introduction

Preterm birth (PTB) is defined as birth before 37 completed gestational weeks. Despite all efforts in modern maternity care, PTB remains one of the most fundamental challenges in obstetrics, and the leading cause of neonatal morbidity and mortality [1]. Preterm neonates are at an increased risk for a wide range of adverse neonatal outcomes, in addition to the burden of considerable economic consequences that they cause for affected families and health services [2]. According to Leli et al [6], the colonization with Candida spp. occurs more frequently in pregnant compared to non-pregnant women (31.4 vs 19.9%). Pregnant women are more often suffering from asymptomatic Candida spp. colonization than their non-pregnant counterparts (46.5 vs 16.0%) [6]. Apart from bacterial vaginosis, which has extensively been studied for its effect on pregnancy outcomes, there is evidence that even an aerobic bacterial infection during pregnancy should be treated to

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