Thrush during pregnancy and lactation

Thrush during pregnancy is a disease caused by yeast-like fungi Candida spp. (spp – different types). In anonymous surveys of women, nine out of ten respondents confirm the presence of vaginal thrush at different periods of life.

Vaginal thrush is not a sexually transmitted infection, but due to its specific location, it is often considered in conjunction with STDs. A direct connection of vaginal thrush with the anatomical features of the female genital organs, regular cycles, and possible pregnancy has been proven. The pathogenesis of thrush during breastfeeding is somewhat different, it is a consequence of cracking of the nipples with abundant milk production. The significance of candidiasis during pregnancy and lactation, their danger and consequences is a discussed topic in the female environment.

Is thrush dangerous during pregnancy?

From the clinical practice of obstetrician-gynecologists, descriptions of the most significant, for the body, consequences of thrush during pregnancy are taken, namely:

• PRPO (premature rupture of membranes). The reasons are manifold and not fully understood. In some sources, the root cause is the inflammatory processes of the membranes caused by pathogenic microflora, in combination with candida. Mechanical and toxic irritation of the mucous membranes provokes inflammation of the uterus (cervicitis), violates the integrity of the membranes. As a result, water simultaneously or fractionally penetrates into the birth canal of a pregnant woman. Diagnosed before 37 weeks of gestation. PROM is one of the causes of neonatal mortality due to sepsis, prematurity, and underdevelopment of the lungs.

• Candidal infection of the fetus. Fungi Candida spp. do not penetrate the placental barrier, so intrauterine infection of the fetus is practically excluded. Infection occurs when the fetus moves in the birth canal. Diagnosed in the first days of life. In severe cases, it causes sepsis and systemic damage to the organs of the newborn.

• Thrush complicates the examination of a pregnant woman. Candida fungi, in combination with chlamydia, mycoplasmas, and other pathogens of sexual infections, cause inflammation, erosion, ectopia (pseudo-erosion) of the uterus and cervix. During colposcopic examination, inflammation caused by thrush is falsely mistaken for dysplasia (the presence of atypical, precancerous cells) of the cervix.

• Thrush is an allergy provocateur. Fungal metabolites cause sensitization (hypersensitivity) of the body weakened by pregnancy to various allergens.

Signs and symptoms of thrush during pregnancy

The first, subjective sensations that sick women pay attention to:

• Itching, burning, discomfort at rest, during intercourse, urination;

• Edema of the labia, scratching, rash, sleep disturbance;

• Allocations (plaque) on the visible parts of the external genital organs;

• Without constant hygiene procedures, the unsharp smell of sour milk;

• Thrush in combination with bacterial vaginosis is felt with a rotten smell.

Some pregnant women indicate a combination of thrush with abundant vaginal discharge. During pregnancy, vaginal discharge may be normal. Brightness, discomfort, depends on individual sensitivity. Hypersensitivity (allergy) of a pregnant woman to fungi is accompanied by debilitating itching. The presence of subjective signs is not sufficient basis for making a final diagnosis. The differential diagnosis of thrush is carried out according to the traditional scheme: history taking (survey), external and internal examination, instrumental and laboratory examination methods.

Anamnesis. The diagnostic value of conversations with the patient can be high, for example, when determining the social behavior of a woman (frequent change of sexual partners, unprotected sex), identifying the living conditions of pregnancy. When questioned, the doctor excludes symptoms characteristic of: sexually transmitted diseases, diabetes, allergies, non-infectious inflammation of the genital organs, other pathologies accompanied by itching and other similar symptoms.

External and internal gynecological examination. Symptoms are detected visually and with the help of a vaginal mirror. With the naked eye, in the region of the cervical canal, a focal plaque of a curdled appearance, white or its shades is visible. On the mucous membranes, pink foci are possible – evidence of erosion. Mucous discharge is colorless or white. Yellow or green mucus, purulent discharge is a reason for differentiating thrush from genital infections accompanied by purulent inflammation. Ulcers and cracks in the mucosa, not mandatory signs of thrush. Often they indicate a strong impact of infectious, allergic agents.

Microscopy of a vaginal smear. Thrush is confirmed by microscopy of a native (unstained) and/or stained smear. In the field of view of the microscope, a large number of candida colonies (pseudohyphae) growing in a chain can be seen. An indicator of a healthy vaginal microflora is the detection of at least 95% of Dederlein sticks in the field of view of a microscope. Dederlein’s stick is an association of lactobacilli: L. acidophilus, L. casei, L. Fermentum, L. Cellobiosus. The vaginal flora is also considered healthy if less than 95% of rods are detected against the background of a small amount of other facultative flora, including candida, with single inclusions of erythrocytes, leukocytes. A dangerous symptom is the presence of a large number of leukocytes of pathogenic microflora and candida against the background of a minimum of Dederlein’s sticks.

Seeding of clinical material. The method has a high diagnostic value. Candida is sown on simple and selective nutrient media. Cultivated at a temperature of 30-37^о C and pH 6,0-68. Using various laboratory techniques, it is possible to differentiate:

• candida from bacteria, protozoa;

• species composition of fungi inhabiting the vagina;

• pathogenic and saprophytic forms of candida;

Another important sign of the pathogenicity of thrush is the determination, in the field of view of a microscope, the number of colony-forming cells per milliliter of clinical material (CFU / ml). The method is used to differentiate the pathological development of thrush from the harmless carriage of fungi. It is considered to be:

• asymptomatic carriage of candidiasis, the value is less than 10⁴  cfu/ml;

• clinical course of thrush, the value is greater than 10⁴ CFU/ml

To detail the pathogenesis, the interdependence of thrush to other damage to the body, immunological, allergic studies, biological tests on laboratory animals are used.

Causes of thrush during pregnancy

Yeast-like fungi can, for a long time harmlessly, coexist in association with beneficial bacteria in the body. Fungal growth is inhibited mainly by natural antagonists, lactobacilli. Under certain conditions, candida begins to grow rapidly, causing a mechanical and toxic effect on the body.

For the pathogenic development of thrush, it is necessary that the state occurs in the body:

• depression of lactobacilli, other beneficial microflora, intestines, vagina;

• hormonal disorders of the body under the influence of internal (diseases of the internal secretion organs or physiological hormonal changes in the female body) or external causes (long-term use of hormonal drugs);

• damage to natural barriers (cracks, erosion of waterlogged mucous membranes), impaired immune cooperation (infections, taking medications – immunomodulators);

• hypersensitivity of the body to fungal metabolites.

Thrush in pregnant women occurs against the background of hormonal changes, accompanied by morphophysiological changes in the body. The most significant changes in the body of pregnant women are highlighted, indicating their increased predisposition to vaginal thrush:

• Under the influence of progesterone, the friability of the mucous membranes of the birth canal increases. In combination with other factors, this greatly facilitates the adhesion (sticking) of fungal colonies on the mucous membranes of the birth canal;

• An increase in the total volume of circulating blood up to 40%, a drop in the amount of blood proteins to 7 g / l provokes a tendency for pregnant women to edema. Increased moisture of the mucous membranes, with edema, in combination with other factors, a favorable factor for the growth of candida;

• An increase in the erythrocyte sedimentation rate (ESR) from 50 mm/h and above, accompanied by anemia in pregnancy and vitamin B deficiency₁₂ (cyanocobalamin). Vitamins are important regulators of metabolism. Particularly vitamin B₁₂ necessary to maintain the beneficial microflora of the vagina and intestines.

• An increase in the level of female sex hormones involved in the synthesis of glycogen lowers the renal filtration threshold, provokes glucosuria (sugar in the urine) of pregnant women. Sugar in the urine is one of the most important private causes of thrush.

• metabolic acidosis. Even with a normal pregnancy, under the influence of increased chest breathing, the phenomena of weak metabolic acidosis are possible. Some sources describe the stimulating effect of metabolic acidosis on Candida.

• During pregnancy, the sebaceous and sweat glands function in an enhanced mode. Increased moisture in the folds of the body stimulates the growth of candida.

Thrush on the chest and nipples during lactation

Breastfeeding is an important factor in the full feeding, emotional interaction between mother and child. It is sad if there are problems of the lactating gland. One of them is breast milk. It manifests itself as a consequence of vaginal thrush, the result of diaper rash of the breast skin. It is treated by traditional methods (drying) and medicines (antimycotics). The doctor in charge of the postpartum period may prescribe drugs of other pharmacological groups. A more formidable pathology is mastitis or inflammation of the mammary gland. Causes of mastitis (milk stasis, non-infectious and infectious agents). Sometimes thrush on the nipples is called a provocateur of mastitis.

Signs of breast thrush

Breast thrush occurs after the appearance of diaper rash and breast engorgement. The causes of diaper rash are tight, dense underwear, profuse sweating. Engorgement (breast compaction) is a consequence of the overflow of the gland with milk. Without expressing milk, the delicate skin of the nipples cracks, the skin of the breast becomes shiny, the nipple stretches to a flat state. Candida colonization is possible on diaper rash or cracks. Damage is felt by pain at rest and during feeding. On the nipples and in places of diaper rash, a white coating. candida opens the gate of infection to the mammary gland. Soreness is provoked by a woman’s refusal to breastfeed or pump. As a result, stasis (stop) of milk flow occurs, then candida and other agents initiate the pathogenesis of mastitis.

Causes of thrush during lactation

The causes of thrush during lactation are similar to the causes of vaginal thrush. Disruption of the balance of normal intestinal microflora after antibiotic therapy, a decrease in overall resistance in the postpartum period, a sharp cessation of estrogen production by the placenta, a violation of the integrity of the natural skin integument. The specific cause of lactational thrush is the improper application of the child during feeding, which provokes cracking of the skin of the nipples. Candida is the most likely cause of recurring, after curing, mastitis.

Can you breastfeed with thrush?

Neonatologists have noticed that thrush is not always transmitted to the baby. Cases of thrush are described only in a mother or child, especially with a latent course of the disease. However, the fungi found in the infant’s mouth are identical to the fungi that cause other candidiasis. Therefore, comprehensive recommendations on breastfeeding, with breast thrush, can be given by a doctor who monitors the health of the newborn and mother. In case of acute pain, it is advisable to refuse feeding from the affected breast. Milk, during the treatment period, is expressed, not used for feeding.

Treatment of thrush during pregnancy

The 1st trimester is considered the most dangerous and difficult period for the treatment of thrush during pregnancy. During this period, the fetus actively grows and develops. When forming the organs and systems of the unborn child, taking medications for pregnant women is contraindicated.

In the first weeks of pregnancy, the occurrence of thrush is a rare phenomenon. As time goes on, the risk increases. For the treatment of pregnant women in the 2-3 trimester, there is a sufficient number of effective drugs. There are suppositories that can be taken with caution at any time, however, a complete cure for thrush is almost impossible. It is not uncommon for doctors to monitor the course of the disease throughout pregnancy.

Preparations for the treatment of thrush by trimesters of pregnancy:

Features of the treatment of thrush during the period of bearing a child

• For the treatment of thrush during pregnancy, the use of topical treatments is acceptable. In the 2nd and 3rd trimester, taking pills is possible only with the permission of the doctor.

• Douching during pregnancy is not recommended, especially if you plan to use aggressive agents. Douching with manganese, baking soda and chlorhexidine is strictly prohibited.

• Pimafucin candles are considered the safest. Application is permissible in the 1st trimester, after childbirth, during breastfeeding.

• The treatment course is important to complete. Even if after using 2-3 suppositories the symptoms of thrush have disappeared, the treatment is continued.

• Burning and discomfort at the beginning of the treatment course should not be a reason for refusing to use candles. This is temporary discomfort.

• If at least a single sign characterizing thrush was noticed during pregnancy, it is necessary to undergo a course of treatment before childbirth.

• The course of treatment is also recommended for the sexual partner, even if he has no symptoms and complaints.

• When treating with antibiotics during pregnancy, drugs for thrush are used as a prophylactic.

• After treatment, no later than two weeks, a sowing is done from the vagina, this is necessary to control the condition.

Candles from thrush during pregnancy

The appearance and development of thrush during pregnancy is most often associated with a weakened immune system. Many drugs for women in position are contraindicated.

There are those whose safety has not yet been proven, and this is always a risk to the health of the unborn baby and the mother herself. 

Nowadays, the pharmacy assortment offers a fairly large selection of antifungal drugs that are actively used in gynecology.

During pregnancy, the choice of funds must be entrusted to the doctor, since from the available variety of suppositories from thrush, there are few allowed for pregnant women:

• Candles Primafungin and Pimafucin.

• Macmirror complex (active ingredients Nystatin and Nifuratel).

From 14-15 weeks of pregnancy are appointed:

• Nystatin

• Clotrimazole

• Gino-Pevaril

• means Bura

• Pimafucin

• Gynofort (cream).

These drugs require careful use, they are used in cases where the risk to the health of the mother is higher than for the unborn child.

Sometimes pregnant women are prescribed Terzhinan. The instructions for the drug indicate possible side effects. Terzhinan contains prednisolone (a hormonal drug). It can be used for treatment, but not before the second trimester and only if there is potential benefit to the pregnant woman.