Abstract:

Background: Vulvovaginal candidiasis (VVC) is a common fungal infection, particularly prevalent among pregnant women due to hormonal and immunologic changes. VVC has been linked to various adverse pregnancy outcomes, including preterm birth and low birth weight. This study aimed to assess the management practices, treatment outcomes, and factors associated with unfavorable pregnancy outcomes among pregnant women with VVC at Bugando Medical Centre (BMC), Mwanza, Tanzania.

Methodology: A retrospective cross-sectional study and desk review of guidelines for the management of VVC was conducted. The study included medical records data from January 2021 to December 2023. Data on demographics, clinical presentations, management practices, and pregnancy outcomes were collected and analyzed. Descriptive statistics were used to summarize the findings, and logistic regression was applied to assess factors associated with unfavorable pregnancy outcomes.

Results: There is similar recommendation on management of VVC among pregnant women between CDC, WHO and STG which required laboratory investigation for confirmation of VVC and use of topical antifungal for uncomplicated cases. However, the STG gave options of clinical diagnosis where laboratory capacity was limited to conduct test for fungi diagnosis.
The study included medical record data of 3,023 pregnant women attending antenatal care at BMC. The majority of participants were multiparous women aged 30-39 years. VVC was documented in 354 (11.7%) of pregnant women. Among pregnant women with VVC, the common clinical presentations were per vaginal discharge 91.0% (322, n=354) and vulva itching 91.8% (325, n=354). Laboratory investigations were performed in only 12.4% (44, n=354) of patients documented with VVC. Topical antifungals (either vaginal pessaries or cream) were prescribed to 322(96.4) of patients. Complete cure was documented in 97.9% (333, n=340 with complete data), while 4 (1.2%, n=340) patients reported to be experiencing symptom recurrence and 3(0.9%, n=340) reported persistence symptoms. On logistic regression analysis having VVC was not associated with unfavorable pregnancy outcome p=0.96%, multiparity was significantly associated with unfavorable pregnancy outcomes (OR 9.53, 95% CI 1.36- 71.7, p=0.029).

Conclusion: There is a slightly deviation on management of VVC among pregnant women from guidelines recommendations with good treatment outcome. The unfavorable pregnancy outcome is not associated with VVC. Adherence to guidelines while managing pregnant women with VVC is recommended. Father study to investigate reasons of clinicians not relying on laboratory results while managing women with VVC is needed.

Keywords: Vulvovaginal candidiasis, pregnancy outcomes, antifungal treatment, management practices, Bugando Medical Centre.