Microbiological Profile, Virulence Attributes and Antifungal Susceptibility of Vulvovaginal Candidiasis Among Pregnant Women: A Cross-Sectional Study

Background: Vulvovaginal candidiasis (VVC) is one of the most common fungal infections encountered during pregnancy. Hormonal alterations, immunological modulation, and changes in vaginal microenvironment predispose pregnant women to Candida colonization and symptomatic infection. The increasing emergence of non-albicans Candida species and antifungal resistance has posed diagnostic and therapeutic challenges, particularly in pregnancy where treatment options are limited. Aim and Objectives: To determine the prevalence of vulvovaginal candidiasis among pregnant women, identify the species distribution of Candida isolates, evaluate associated risk factors and virulence determinants, and assess antifungal susceptibility patterns. Materials and Methods: This cross-sectional study included 50 pregnant women presenting with symptoms suggestive of VVC at a tertiary care center. High vaginal swabs were collected and processed using standard mycological techniques. Candida isolates were identified to species level. Virulence factors such as biofilm formation and phospholipase activity were assessed. Antifungal susceptibility testing was performed using the CLSI disc diffusion method. Results: Out of 50 pregnant women, 28 (56%) were culture positive for Candida species. Non-albicans Candida (57.1%) predominated over Candida albicans (42.9%). The highest culture positivity was observed in the third trimester. Biofilm production was detected in 71.4% of isolates, while phospholipase activity was observed in 21.4%. Amphotericin-B (96.4%) and voriconazole (85.7%) showed the highest antifungal sensitivity, whereas fluconazole and nystatin demonstrated moderate resistance. Conclusion: Vulvovaginal candidiasis remains highly prevalent among pregnant women, with an emerging dominance of non-albicans Candida species exhibiting significant virulence traits. Routine species identification and antifungal susceptibility testing are essential for optimal management and prevention of recurrent infections during pregnancy.