Aguin T J, Sobel J D
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
Curr Infect Dis Rep. 2015 Jun;17(6):462. doi: 10.1007/s11908-015-0462-0.
Prevalence studies indicate that Candida species colonize the vagina in at least 20 % of all women, rising to 30 % in pregnancy. Although, some studies concluded that pregnant women were more likely to have symptomatic vaginal infections caused by Candida, yet other studies found a high prevalence of asymptomatic infection only during pregnancy. Most episodes of symptomatic vulvovaginal candidiasis (VVC) occur during the second and third trimesters. The increased risk of VVC in pregnancy is likely sustained by pregnancy-related factors, such as immunologic alterations, increased estrogen levels, and increased vaginal glycogen production. Although evidence is incomplete, there is some emerging data which suggests that candidiasis in pregnancy may be associated with increased risk of pregnancy complications, such as premature rupture of membranes, preterm labor, chorioamnionitis, and congenital cutaneous candidiasis. In contrast to nonpregnant women, there are no formal studies, evaluating the use of long-term suppressive maintenance oral azoles in the treatment of recurrent VVC (RVVC) in pregnancy. Most clinicians do not offer suppressive therapy in pregnancy and prefer to treat individual symptomatic episodes only utilizing a topical imidazole vaginally for 7 days to minimize systemic exposure to medications.
患病率研究表明，至少20%的女性阴道内有念珠菌定植，孕期这一比例升至30%。尽管一些研究得出结论，孕妇更易发生由念珠菌引起的有症状的阴道感染，但其他研究发现仅在孕期无症状感染的患病率较高。大多数有症状的外阴阴道念珠菌病（VVC）发作发生在妊娠中期和晚期。孕期VVC风险增加可能与妊娠相关因素有关，如免疫改变、雌激素水平升高和阴道糖原生成增加。尽管证据不完整，但有一些新数据表明，孕期念珠菌病可能与妊娠并发症风险增加有关，如胎膜早破、早产、绒毛膜羊膜炎和先天性皮肤念珠菌病。与非孕妇不同，目前尚无正式研究评估长期抑制性维持口服唑类药物治疗孕期复发性VVC（RVVC）的疗效。大多数临床医生在孕期不提供抑制性治疗，而是更倾向于仅使用局部咪唑类药物经阴道治疗7天来处理有症状的个别发作，以尽量减少药物的全身暴露。
