Health of pregnant women
Thrush in pregnancy: is there any danger to the fetus?
Probably, it is difficult to find a woman who has never encountered thrush in her life. And during pregnancy, the risk of developing this disease increases. In addition, for future mothers it is not as harmless as many people think. What is dangerous for thrush during pregnancy and how to avoid this ailment?
Victoria Rzaeva obstetrician-gynecologist, Moscow
Thrush is a common name for the candidiasis of the vagina. The name "thrush" arose associatively: the disease accompanies white curdled discharge from the vagina, as well as an acidic odor, swelling, itching and reddening of the labia. Unpleasant sensations can intensify in the evening and at night, during intimacy, after urination. Strictly speaking, the cause of candidiasis is one - the yeast-like fungi of the genus Candida, most often the species of Albicans, but sometimes other types of fungi can be the causative agent of the disease. However, there are several different factors that can provoke their growth and development. Let us consider them in more detail.
Hormonal changes. During pregnancy, the body produces a large amount of estrogen, and it, in turn, activates the formation of mucus and vaginal discharge. Normally, they are liquid and transparent, or white, after drying can acquire a yellowish tint, do not have a sharp odor. If the secretions have changed color and consistency, have acquired an unpleasant smell, most likely, this is a sign that the growth of pathogenic microorganisms is taking place in the vagina. Often, such manifestations indicate candidiasis. Happens, that the thrush appears and in the beginning of pregnancy, many women even consider it as one of indirect signs that fertilization has occurred. At this time, under the influence of the hormone progesterone, the acidity of the vagina changes and the amount of glycogen increases (this is a complex carbohydrate consisting of glucose molecules, which the fungi "eat", at the beginning of pregnancy, under the influence of progesterone, the number of cells lining the vagina increases, they accumulate more glycogen, the norm should be cleaved by the beneficial lactobacilli, maintaining the normal acidity of the microflora (pH to 3.8-4.5), but then yeast microorganisms are also activated, their number starts to grow And the medium becomes weakly alkaline), which creates excellent conditions for the growth of fungi.
Weak immunity. Normally, the fungus is present on the skin and mucous membranes of most people (not only women, but also men) and does not manifest itself in any way, but under certain circumstances it activates and begins to interact with other microorganisms, which leads to the development of candidiasis. One of the risk factors is reduced immunity. It is worth the body to relax a little, Candida rush to take advantage of the moment and begin to multiply. The onset of pregnancy, as a rule, is associated with a decrease in the protective functions of the body. The reason is that the embryo half consists of the genetic information of the father, therefore to some extent it is an alien agent for the mother's organism. It would seem that the immune system should immediately respond to the invasion and attack the "troublemaker". But in this case the fertilized egg can not attach to the uterine surface and develop normally. To make this possible, the body temporarily reduces vigilance. The process can be compared to the work of a sensitive computer antivirus: sometimes, to install some programs, you have to change its settings or completely disable it. Approximately the same happens with immunity. But, as usual, everything has its pluses and minuses, the weakening of protective functions can lead to the growth of pathogens, including Candida, which cause thrush during pregnancy.
Poor hygiene. Inadequate intimate hygiene contributes to the development of vaginal infection. Slowing the reproduction of Candida mushrooms will help to observe the following hygienic rules: regular water procedures should be carried out after washing hands. Wash better several times a day - from front to back, to exclude infection from the intestine. It is better to use warm water and baby soap or special means for intimate hygiene, restoring normal pH. Antibacterial is better not to use: of course, it effectively eliminates fungi, but at the same time exterminates a useful microflora. It is also good if the composition of the means for intimate hygiene will include lactic acid, as it is normally present in the vaginal secretion. After washing, gently blot the genital area with a clean towel. Avoid using flavored salt and bath foam, as well as intimate products containing perfume and colorants. Choose soft, multi-layered toilet paper to protect the genital area from micro-traumas (the direction of movement here should be the same as when washing). Remember that in matters of hygiene it is important to keep balance. So, too frequent water procedures, especially with the use of soap or other aggressive detergents, can dry the mucous membrane. Active syringing, used for treatment, can also give an undesirable effect - not to rid of candidiasis, but on the contrary, aggravate its symptoms. When syringing using various, sufficiently aggressive, antibacterial solutions (iodine, manganese, peroxide, chlorhexidine and others), the natural microflora of the vagina is disrupted, which only provokes the further development of thrush.
Unsuitable underwear. To provoke the development of thrush can also be too tight and dense underwear, especially from synthetic fabrics: it poorly passes air, hinders heat emission and enhances sweat release, creating a warm and moist environment, the most optimal for reproduction of the fungus. Choose not too tight-fitting cotton underwear (for the beginning it is possible to buy linens on the size more than you wore before pregnancy). Also for the prevention of thrush development, daily non-flavored pads can be used. They need to be changed regularly, as they become contaminated.
Incorrect food. It can often be heard that the development of candidiasis is associated with active consumption of sugar, which is processed into glucose, and that, in turn, promotes the propagation of Candida. However, studies confirm that this opinion is only partially true, since the blood glucose is regulated by the hormone of the pancreas with insulin, and normally remains approximately at the same level. Failure can occur with endocrine diseases - in the first place it is diabetes, disruption of the thyroid gland and hypothalamus. In this case, the probability of thrush is indeed increased.
Also, the development of candidiasis can be due to the lack of beneficial bacteria in the microflora, to increase their amount of help dairy products. Especially effective are natural yogurts without additives. It's best to do them yourself, at home, using a special yogurt or multivark - it's very simple, convenient and profitable, the main thing is to choose a good milk. As a starter it is better to use live lactobacilli (they are sold both in dry and in liquid form). By the way, in addition to milkmaids, natural yoghurts help get rid of many other problems. In particular, to adjust the work of the intestines, which is important during pregnancy.
Taking medication. Another risk factor for the emergence of thrush is the intake of antibiotics and hormone preparations both shortly before and during pregnancy. Antibiotics work efficiently, but their "damage zone" is wide enough - not only harmful bacteria are destroyed, but also useful, while Candida fungi are not always amenable to action. As a result, the vagina creates a favorable environment for their growth and development, resulting in often a candidiasis. By the way, this is why usually, along with the administration of antibiotics (or at the last stage of treatment), drugs containing live lactobacilli are prescribed to normalize the microflora of the vagina and intestine. However, this precaution does not always prove effective, and the thrush nevertheless manifests itself.
The state of stress. The cause of thrush, and many other diseases, can be long-term stress. It, in turn, causes hormonal imbalance and impairment of immunity. Due to strong experiences in the female body, the production of the hormone cortisol is enhanced - it helps to stay "afloat", but at the same time depresses the work of the immune system. As a result, the overall level of protection against a variety of infections, including from the fungi of the genus Candida, is reduced. By the way, the disease can manifest itself after the completion of a difficult situation, and not during it.
Treatment of thrush during pregnancy
Before embarking on the treatment of thrush, it is important to make sure that the diagnosis is correct, since some other diseases, for example, gardnerellez (bacterial vaginosis) or some sexually transmitted diseases seem to manifest themselves. For this, the gynecologist during the examination takes a swab from the vagina and gives it to the study. The analysis allows to determine the presence of candida in the microflora, to estimate its quantity and, if necessary, to find out which of the antifungal preparations is best for treatment. Sometimes, in the presence of symptoms, thrush is also recommended to make a bacterial sowing from the vagina. This analysis allows you to exclude the presence of gonorrhea, trichomoniasis, nonspecific colpitis, to conduct an examination for chlamydia, human papillomavirus, herpes. Also, the doctor conducts a survey of the patient, finding out the details of her lifestyle and the presence of factors that provoke the development of candidiasis. It is also important to exclude various diseases that affect immunity. To do this, make an immunogram - a blood test, which allows you to identify the presence of problems with immunity. Sometimes it is necessary to consult in addition to other doctors, for example, to consult an otolaryngologist. Chronic diseases of the nasopharynx (sinusitis, laryngitis, tonsillitis) can weaken the immunity and thus contribute to the appearance of thrush. Of course, getting rid of chronic inflammation is better during pregnancy planning, but, unfortunately, this does not always work.
If the disease manifested itself in the period of bearing the child, there arises a natural question: is it worthwhile to treat it immediately or can it be done later? There is no unequivocal opinion on this, but most of the time the thrush is not treated, if the smear shows an increased presence of fungus, but there are no external manifestations of the disease (there is no itching, burning, characteristic discharge).
For the treatment of candidiasis, the doctor selects the drugs that are allowed for use during pregnancy, most often vaginal suppositories and creams used locally: they are effective enough, but it is important to remember that the effect may be worse if there is insufficient contact with the mucosa (for example, if the allocation is too abundant ).
After antifungal agents, often prescribed drugs containing beneficial bacteria, they colonize the mucous and do not allow fungi to multiply. In addition, the regimen for treatment of thrush often includes immunomodulating drugs, as well as vitamin complexes. Unfortunately, during the period of gestation, thrush often occurs repeatedly, in this case the treatment is repeated.
Is candida infection dangerous for a future mother and baby?
In addition to some discomfort arising from thrush, the disease most often does not have a significant effect on the mother's body and on the development of the fetus. However, in some cases, the products of the life of Candida fungi can cause damage to the membranes of the bladder. As a result, a rupture or crack may occur, through which amniotic fluid will flow, through which an infection can penetrate. Sometimes a fungus can get to the fetus even through whole fetal membranes, usually the umbilical cord, lungs and mouth of the fetus are affected. Also, a child can become infected during the process of birth, passing through the vagina, in this case he is diagnosed with candidal stomatitis: white spots appear on the tongue and on the oral mucosa, a diaper rash occurs. By the way, the presence of an inflammatory process makes the vaginal tissues less elastic, which increases the risk of rupture in childbirth.
In addition, during breastfeeding, breast milk can develop, especially if the woman already has a vaginal thrush. Candida fungi penetrate into the cracks on the nipples, resulting in inflammation, itching, flaking, the skin becomes bright pink or red, and small white spots may appear. Usually, breastfeeding is not interrupted for the duration of treatment, because quite often the child becomes infected from the mother and also needs the use of medicines.
Treatment of candidal stomatitis in a baby and breast milk is usually carried out together with the mother, the child is given special oral preparations, an antifungal cream is used for the nipples. All items falling into the child's mouth (nipples, toys, bottles) are carefully sterilized after each use.
In any case, it should be remembered that although the symptoms of thrush are unpleasant and can cause severe discomfort, this disease is treated quickly enough and effectively. The main thing is to consult your gynecologist and find the right drugs.