Prevalence and outcome of vulvovaginal candidiasis among pregnant women: A study at a tertiary care hospital

Background: Vaginal Candida colonization increases to 30% during pregnancy. This is a significant concern due to emerging evidence linking vulvovaginal candidiasis (VVC) with a higher incidence of pregnancy-related complications. The objective of this study is to estimate the prevalence of VVC among pregnant women attending the obstetrics and gynaecology outpatient department and to determine their pregnancy-related outcomes at a tertiary care hospital in Eastern India. Methodology: This was a prospective study conducted over an 18-month period from September 2017 to February 2019. Clinical histories, along with high vaginal swabs, were collected and processed. The samples were screened for budding yeast-like cells using Gram staining, inoculated onto Sabouraud dextrose agar with chloramphenicol plates, and incubated at 25°C and 37°C. Germ tube tests were performed; the Candida species were subcultured on HiCrome Candida Differential agar (Himedia, Mumbai, India) and incubated at 37°C for 24 to 48 h. Species were identified based on the type and color of the colonies on the media. Results: The culture positivity rate for VVC was 30.27%. The highest occurrence of VVC was noted in women aged between 30 and 35 years, during the second trimester, and among nulliparous women. Candida albicans was the most common isolate (69.06%), followed by Candida glabrata (19.64%) and Candida krusei (10.71%). The majority of cases with C. albicans were symptomatic. Although not statistically significant, the incidences of premature rupture of membranes, preterm delivery, and low birth weight were higher among pregnant women with VVC. Conclusion: VVC during pregnancy is a condition that must not be overlooked. Screening for fungal infections during antenatal examinations is crucial. The upsurge of non- Candida albicans is alarming, as these species exhibit greater resistance to commonly used antifungal treatments and are challenging to manage.