Oral fluconazole is a treatment for nonpregnant patients with candida vulvovaginitis. However, the use of oral fluconazole during the first trimester is associated with a risk of spontaneous abortion and congenital defects (eg, cleft palate, femoral bowing, congenital heart disease). Therefore, oral fluconazole is not recommended during pregnancy.
Vulvovaginal candidiasis during pregnancy is not associated with adverse outcomes; treatment is indicated for symptomatic relief. First-line options include vaginal clotrimazole, miconazole, and nystatin, all of which are safe during each trimester.
The first-line antibiotic regimen is single-dose oral metronidazole 2 g. However, metronidazole enters breast milk and may cause loose stools and candidiasis in exposed infants. Although 1 dose of metronidazole is not an indication for complete cessation of breastfeeding, breast milk produced immediately after treatment has a significant concentration of metronidazole. To minimize infant exposure, breastfeeding should be discontinued; breast milk should be expressed and discarded for 24 hours after dose administration.