A Patient's Guide to Candida in Pregnancy

I love everything about pregnancy! Obviously, it's why I do what I do. Except yeast infections, I don't love those. Yeast infections are no fun! Especially when you are pregnant. Itchy and irritated rashes, smelly discharge, burning and soreness are all things no pregnant woman wants to deal with. These little fungi are not only irritating but can be dangerous by increasing the risk of Premature Rupture of Membranes from infection (PROM)[1]. Candida in pregnancy should always be taken seriously. That doesn't mean, though, that it cannot be treated without prescription antifungals. In fact, the success rate in treatment with diet (with or without medication) is greater than medication alone [2]. 

Written by Sarah Thompson CFMP, L.Ac., Doula

Are You Battling Candida in Pregnancy?

Yeast infections during pregnancy are much more common than you would think. Some estimate up to 75% of pregnant women have some level of yeast infection, with 30-40% needing treatment. 40% of those treated with antifungals will have a relapse and need a second dose of medication in treatment [3].

Vaginal Candida Symptoms

The severity and location of symptoms can vary significantly dependent on the woman's microbiome, and immune health. But in generals symptoms can include:

• Cottage Cheese like discharge (you'll never look at cottage cheese the same again)
• Yeasty or bread like smell (or bread)
• Vulva inflammation
• Vulva and Vaginal itchiness
• Pain with urination
• Pain with Intercourse (because sex while pregnant is already awkward enough, why not add candida)
• Symptoms worsen after intercourse

What Causes the Increase of Candida in Pregnancy?

Yeast infections during pregnancy are pretty common, and can be caused by a number of different underlying conditions. Yeast play an important role in eating dead cells of the blood, skin, and mucosal layers. When there is an imbalance in the diet, bacteria, or hormones, candida can overgrow and become a problem. 

• ​Normal Flora & Candida: There should be a natural balance between the yeasts and bacteria of the body. When the balance is off, with a higher ratio of candida to bacteria, we get overgrowth. 
• Pregnancy Hormones and Candida: Estrogen helps Candida grow! In lab studies, candida that is exposed to Estradiol (the estrogen of pregnancy) increased in size and structure…it grows and multiples, and becomes stronger. Estrogen exposed candida are also more resistant to medications.
• Minerals and Candida: Candida binds to minerals like Iron, Zinc, and Magnesium and uses them as fuel. This actually becomes tricky in pregnancy, as your body needs more minerals for hormones and growth processes. Too much though and you can be fueling candida growth. Because of this connection, chronic candida infections can increase the risk of anemia in pregnancy.

Common Treatments

It's sad to me that most western medicine providers on not trained in dietary and nutritional therapy. They are, however, well trained in medication therapy (which is sometimes the best course of action). 

1. ​Antifungals: There are multiple types of antifungals available for treatment. In general all antifungals are hard on the body. The primary type of anti-fungal used in pregnancy are the azole antifungals (a mix of imidazole and triazole antifungals) in topical form. Topically these are pretty safe.Oral azole antifungal treatment is considered a secondarily line of defense in severe cases as it is associated with an increased risk of miscarriage and birth defects [4].
2. ​Antiseptics: Topical Boric acid is sometimes used in place of antifungals in treatment during pregnancy. Boric Acid interferes with the natural life cycle of candida, thus killing them. Although it is considered safe in pregnancy, and absorption through the vaginal mucosa is limited, some research has linked Boric Acid use to severe fetal deformities [5].
3. ​Corticosteroids: Corticosteroids do not treatment the cause of candida, or kill the candida, they are used to alleviate the irritating symptoms caused by candida. These are usually topical creams used on the exterior labia to alleviate itching and redness associated with infection. 3% of the steroid cream is absorbed through the skin. Some studies link topical steroid use in pregnancy to an increase in cleft palate and other deformities [6].

Natural Supplement Treatment

Common medication treatment runs the risk of possible interactions and birth defects. If symptoms are mild and caught early, treatment with natural supplements should be a first line defense. Even if treatment with antifungals is necessary for the prevention of childbirth and pregnancy complications such as preterm labor, these supplements can be used to increase medical treatment success and prevent relapse.

• Probiotics:​ Probiotics, in a hefty dose are crucial to treatment. Lactobacillus rhamnosus is the most important for controlling yeast overgrowth, second is Lactobacillus Acidophilus, as are soil bacteria (not found in lactic acid fermentation)…dosages can and need to be pretty high starting at 100billion per day and going up to 300billion per day. Some of the brands that I personally like are Prescript-Assist (soil bacteria), and Klaire Labs Ther-Biotic Complete Powder. The Klaire Labs powder can be used mixed with Coconut Oil as a vaginal topical. 
• Sitz Baths: Taking baths with Baking Soda can be helpful at reducing exterior inflammation and removing infection from the vagina.
• Garlic: Fresh garlic is best, as the anti-bacterial properties of Allicin (the active ingredient) are lost quickly after crushing the clove. 

Dietary Treatment

The goal of dietary therapy in most candida diets is to starve out the yeast by depriving it of the foods likes, such as sugars and dairy. I have another approach as well. In my Candida diet we increase the foods that have been shown have antifungal properties. Some of these foods are often left off of most other candida diet lists because they are high glycemic. In phases of pregnancy we need additional glucose to fuel fetal development so depriving the body of all carbs (even the good ones) may not be the best idea. The general guidelines of my candida diet are not just about macronutrients, but about the micronutrients and lifestyles needs during pregnancy.

1. Remove Simple Carbohydrates: This includes breads and pastas, natural sugars like pasteurized honey (raw, unfiltered is different because it contains anti-microbial compounds), Maple Syrup, and many types of fruits (some are okay, as they contain compounds that are anti-microbial as well and kill candida). 
2. Avoid Starchy Vegetables: The sugars and carbs in the veggies, can feed candida. (There are exceptions to this rule, like Sweet Potatoes)
3. Avoid Dairy: Milk is full of lactose and estrogen (naturally occurring), which Candida loves. Aged cheeses are made with molds, and for the time being even yogurt should be avoided. Grass-Fed Butter is the only exception, as the nutrition it provides is important in pregnancy and the treatment of candida
4. Avoid Xenoestrogens:  Xenoestrogens fuel candida growth among other horrible things. Environmental estrogen is found in our body care products, detergents, pesticides, etc…
5. Increase Dietary Fats: Our dietary fats are nutritional powerhouses for our cells. Many are also Candida killers, and anti-inflammatory. 
6. Stay Hydrated: Hydration is, of course, important in pregnancy. With Candida, you will feel dryer and flakier. Staying hydrated the correct way is more important. 
7. Increase Culinary Herbs: Many, like Garlic, Turmeric and Cinnamon, are anti-microbial and kill candida. Fresh is best, and use them to flavor and spice up meals.

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1. Rasti, S., Asadi, M. A., Taghriri, A., Behrashi, M., & Mousavie, G. (2014). Vaginal candidiasis complications on pregnant women. Jundishapur journal of microbiology, 7(2), e10078. doi:10.5812/jjm.10078
2. Otasevic, S. et al. (2018). The Dietary Modification and Treatment of Candida Overgrowth. J. Mycol. Med, 2018 Dec;28(4):623-627. doi: 10.1016/j.mycmed.2018.08.002. Epub 2018 Aug 27
3. Soong, D., & Einarson, A. (2009). Vaginal yeast infections during pregnancy. Canadian family physician Medecin de famille canadien, 55(3), 255–256.
4. Anick Bérard, Odile Sheehy, Jin-Ping Zhao, Jessica Gorgui, Sasha Bernatsky, Cristiano Soares de Moura, Michal Abrahamowicz (2019). Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case–control studies. CMAJ,  Feb 2019, 191 (7) E179-E187; DOI: 10.1503/cmaj.180963
5. Acs N, Bánhidy F, Puhó E, Czeizel AE. Teratogenic effects of vaginal boric acid treatment during pregnancy. Int J Gynaecol Obstet. 2006;93(1):55–6. Epub 2006 Mar 10.
6. Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000;62(6):385–92.