Stage-specific vaginal microbial alterations in pregnancy-associated vulvovaginal candidiasis

Vulvovaginal candidiasis (VVC) is highly prevalent in reproductive-age women and poses unique challenges during pregnancy. While previous studies have explored the vaginal microbiota in healthy pregnancies or in VVC-affected nonpregnant women, few have comprehensively evaluated how VVC-associated dysbiosis evolves across gestational stages. In this study, we revealed that microbial diversity, taxonomic composition, and ecological network structures differ significantly across trimesters in women with VVC. Notably, we found that the topological role of <i>Lactobacillus</i>-central to vaginal health-changes dynamically during pregnancy, indicating gestational stage-specific vulnerabilities in microbial resilience. These findings offer new insight into how pregnancy shapes the vaginal ecosystem under pathological conditions and highlight the need for trimester-tailored strategies in the management and prevention of VVC to better protect maternal and neonatal outcomes.