The use of antifungals in pregnancy requires special consideration for the safety of the developing fetus. Clinicians now have an increased repertoire of both topical and systemic antimycotics available to treat superficial or mucotaneous fungal infections including Candida vaginitis. The ability of many nontopical antifungals to penetrate the placenta and achieve measurable, often therapeutic, concentrations in cord blood, fetal tissue and amniotic fluid means that evidence exists of successful treatment of all varieties of systemic fungal disease in pregnant women, even with placental involvement. However, for the same reasons, safety considerations remain a concern.
Although the use of azoles as topical agents for superficial infections is both efficacious and well tolerated, especially when used for short periods, systemic azole therapy is not recommended in pregnancy. Accordingly, amphotericin B remains the drug of choice for systemic, invasive mycotic infections, whether life-threatening or less severe. Unfortunately little if any information is available regarding the safety of the newer lipid formulations of amphotericin B.
There is a general reluctance to perform randomised, comparative studies involving antifungal agents in pregnancy, hence cumulative anecdotal reports form much of the available data; animal studies, although useful, have several drawbacks. There is a need for additional safe and effective new antifungal agents for widespread use in pregnant women.
Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 1985; 152: 924–35PubMedGoogle Scholar
Candidosis of the genitalia. Odds FC, editor. Candida and candidosis. A review and bibliography. 2nd ed. London: Bailliere Tindall Publishers, 1988: 124–35Google Scholar
Cotch MF, Hillier SL, Gibbs RS, et al. Epidemiology and outcomes associated with moderate to heavy Candida colonization during pregnancy. Am J Ob Gyn 1998; 178: 374CrossRefGoogle Scholar
Mazor M, Chaim W, Shinwell ES, et al. Asymptomatic anmiotic fluid invasion with Candida albicans in preterm premature rupture of membranes. Implications for obstetric and neonatal management. Acta Obstet et Gynecol Scand 1993; 72: 52–4CrossRefGoogle Scholar
Donders GG, Moerman P, Caudron J, et al. Intrauterine Candida infection: a report of four infected fetuses from two mothers. Eur J Obstet Gynecol Reprod Biol 1991; 38: 233–8PubMedCrossRefGoogle Scholar
Shalev E, Battino S, Romano S, et al. Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin. Am J Obstet Gynecol 1994; 170: 1271–2PubMedGoogle Scholar
Burns DN, Tuomala R, Chang BH, et al. Vaginal colonization or infection with Candida albicans in HIV-infected women during pregnancy and during the postpartum period. Women and Infants Transmission Study Group. Clin Infect Dis 1997; 24: 201–10PubMedCrossRefGoogle Scholar
Catanzaro A. Pulmonary mycosis in pregnant women. Chest 1984; 86Suppl. 3: 145–85Google Scholar
Hager H, Welt SI, Cardasis JP, et al. Disseminated blastomycosis in a pregnant women successfully treated with amphotericin B. J Reprod Med 1988; 33: 485–8PubMedGoogle Scholar
Ismail MA, Lerner SA. Disseminated blastomycosis in a pregnant women: review of amphotericin B usage during pregnancy. Am Rev Respir Dis 1982; 126: 350–3PubMedGoogle Scholar
Blotta MH, Altemani AN, Amaral E, et al. Placental involvement in paracoccidioidomycosis. J Med Vet Mycol 1993; 31: 249–57PubMedCrossRefGoogle Scholar
MacDonald D, Alguire PC. Adult respiratory distress syndrome due to blastomycosis during pregnancy. Chest 1990; 98: 1527–8PubMedCrossRefGoogle Scholar
Daniel L, Salit IT. Blastomycosis during pregnancy. Can Med Assoc J 1984; 131: 759–61PubMedGoogle Scholar
McGregor JA, Kleinschmidt-DeMasters BK, Ogle J. Meningoencephalitis caused by Histoplasma capsulatum complicating pregnancy. Am J Obstet Gynecol 1986; 154: 925–31PubMedGoogle Scholar
Ely EW, Peacock Jr JE, Haponik EF, et al. Cryptococcal pneumonia complicating pregnancy. Medicine 1998; 77: 15–67CrossRefGoogle Scholar
Saade GR. Human immunodeficiency virus (HIV)-related pulmonary complications in pregnancy. Semin Perinatol 1997; 21: 336–50PubMedCrossRefGoogle Scholar
Elewski BE. Superficial mycoses, dermatophytoses and selected dermatomycoses. In: Elewski BE, editor. Topics in clinical dermatology: cutaneous fungal infections. New York (NY): Igakin-Shoin, 1992: 12–68Google Scholar
Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect dis 1985; 7: 287–313PubMedCrossRefGoogle Scholar