A Narrative Review Vulvovaginal Candidiasis during Pregnancy: A Narrative Review of Prevalence, Risk Factors, and Antibiogram among Pregnant Mothers.

Abstract

Vulvovaginal candidiasis (VVC) is an opportunistic fungal infection of the female lower genital tract caused by Candida spp. and is responsible for 90% of the cases of infectious vaginitis. VVC during pregnancy remains neglected; however, it poses several complications, leaving this uniquely vulnerable group at risk of mismanagement. This study addressed these urgent gaps by synthesizing global prevalence trends, pregnancy-specific risk dynamics, and emerging resistance patterns. The VVC incidence was the highest in East Africa, with Kenya reporting the highest prevalence at 90.38%, which was slightly higher than that reported in Uganda (73.1%) and the lowest in developed countries (61.1%). C. albicans was the predominant Candida spp. isolated from both regions. VVC was associated with the use of hormonal contraceptives, a history of diabetes mellitus, the use of antibiotics, regular douching, the third trimester, and a multigravida status. In developed countries, most Candida spp. are resistant to nystatin and clotrimazole, and are sensitive to miconazole. In sub-Saharan countries, nystatin, and miconazole have good antifungal activity, and C. albicans has the highest sensitivity to miconazole. In Uganda, clotrimazole resistance was the highest in C. krusei. All Candida spp. presented the lowest resistance to nystatin and miconazole. In conclusion, VVC is highly prevalent in East Africa and lowest in developed countries, with C. albican as the dominant causative agent peaking in the third trimester. The increasing resistance to nystatin and clotrimazole in developed countries, and to nystatin, and miconazole demonstrated good antifungal activity in sub-Saharan countries and Uganda. This resistance pattern demands flexibility in empirical therapy for non-C. Albican.