Abstract

Vulvovaginal candidiasis (VVC) is considered the second most common cause of vaginitis after bacterial vaginosis and the most common lower genital tract infection during pregnancy. Candida albicans (C. albicans), an opportunistic pathogen, is the major species causing VVC. Recently, increasing researches have shown that lower reproductive tract infection during pregnancy can lead to various adverse pregnancy outcomes. However, the underlying mechanisms are not fully understood. Hence, we successfully established a mouse model of vaginal C. albicans infection and characterized the adverse pregnancy outcomes. C. albicans infection strikingly increased abortion rate and decreased litter size. Further analysis of placental development demonstrated that placental structure was abnormal, including that the area of spongiotrophoblast (Spo) and labyrinth (Lab) was reduced, and the formation of placental vessel was decreased in Lab zone. Accordingly, the expression of marker genes during placental development was downregulated. Collectively, the above findings revealed that vaginal C. albicans infection during pregnancy can inhibit placental development and ultimately lead to adverse pregnancy outcomes. This study enhances our comprehension of the effect of VVC on pregnancy, and placental dysplasia as a feasible orientation to explore VVC during pregnancy.

Highlights

  • Vaginal microbiota plays an important role in maternal and fetal health

  • All of these results indicated that mice exposed to C. albicans suffered from typical vaginal infection

  • Accumulating studies have confirmed that gestational Vulvovaginal candidiasis (VVC) can lead to premature delivery, abortion, premature rupture of membranes, and other adverse pregnancy outcomes (Mazor et al, 1993; Ilkit and Guzel, 2011; Ali et al, 2012)

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Summary

Introduction

Vaginal microbiota plays an important role in maternal and fetal health. Previous studies confirmed that most vaginal microbial communities (73%) were dominated by Lactobacillus and a dynamic equilibrium state of coexistence of various microbes in physiological conditions (Stapleton, 2016). C. albicans is a conditional pathogen; it is estimated that approximately 10–15% of asymptomatic women are colonized with Candida (Gonçalves et al, 2016). The risk of VVC for non-pregnant women is approximately 20%, but it increases to 30% averagely during pregnancy. There has been evidence indicating that candidiasis during pregnancy may be related to an increased risk of pregnancy complications, such as preterm birth (PTB), abortion, premature rupture of membranes, and other adverse pregnancy outcomes (Mazor et al, 1993; Ilkit and Guzel, 2011; Roberts et al, 2011; Ali et al, 2012). Candida infection is the most common vaginal microorganism in patients in the middle and late trimesters of pregnancy, and it can lead to intrauterine infection, endometritis, chorioamnionitis, and neonatal infection as well as PTB and abortion (Aguin and Sobel, 2015)

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