Bacterial vaginosis, vaginal Candida colonization and antifungal susceptibility patterns in pregnant women of eastern Ethiopia: a prospective study

Bacterial vaginosis (BV) and vaginal candidiasis are prominent causes of vaginal infections, leading to discomfort and negative pregnancy outcomes. Despite their significance, there is limited data on the prevalence, progression, and contributing factors of BV and vaginal Candida colonization among pregnant women in low-resource settings such as Ethiopia. Thus, the aim of this paper is to determine the prevalence and associated factors of BV and vaginal Candida colonization, and antifungal susceptibility patterns in Eastern Ethiopia. Exploratively, we assessed the relationship between these infections and adverse pregnancy outcomes among pregnant women. A total of 217 pregnant women, ranging from 12 to 22 weeks of gestation, were enrolled and followed until birth or pregnancy termination. Data on sociodemographic information, pregnancy history, and current conditions were gathered through interviews. Two vaginal swabs were collected for microbiological analysis, using Nugent scoring for BV, culture and Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry for Candida detection. Data were collected using Redcap and analyzed using STATA version 17. Multivariable logistic regression was employed to identify associated factors at a significance level of p < 0.05. This study indicated that 43% (95% confidence interval (CI): 36.6%, 50.2%) of the participants had BV or vaginal Candida colonization or both. The overall prevalence of BV and vaginal Candida colonization were 27.7% (95% CI: 21.8%, 34.1%) and 23.5% (95% CI: 18.4%, 29.6%), respectively. Factors associated with BV included antibiotic use (AOR = 9.47, 95% CI: 4.09-21.94) and vaginal douching (AOR = 6.93, 95% CI: 2.86-16.77). Similarly, antibiotic use (AOR = 4.18, 95% CI: 1.78-9.80) and vaginal douching (AOR = 5.48, 95% CI: 2.39-12.56) were significantly associated with Candida colonization. BV increased the likelihood of adverse birth outcomes by 1.89 times and preterm birth alone by 3.89 times. BV and vaginal Candida colonization are highly prevalent among pregnant women in Eastern Ethiopia and are associated with modifiable behavioral and clinical factors. The findings underscore the importance of improved understanding of vaginal microbiota dynamics during pregnancy and their potential links with adverse maternal and neonatal outcomes.