Thrush in pregnancy: symptoms and safe treatment

Thrush is a common yeast infection, and pregnancy makes you more likely to get it, especially in the third trimester. It’s uncomfortable, but there’s no evidence it can harm your unborn baby, and it’s usually easy to treat. The main thing to know is that some thrush treatments aren’t suitable in pregnancy, so check before you buy anything.

What causes thrush?

Thrush is caused by a fungus called candida, which normally lives harmlessly in the body. It can grow when the balance in your vagina changes and the area becomes warm and moist. Pregnancy makes it easier to get thrush, especially in the third trimester. Others include taking antibiotics, poorly controlled diabetes, and irritated or damaged skin.

Symptoms of thrush

white discharge, often thick and like cottage cheese, which doesn’t usually smell
itching and irritation around the vagina and vulva
soreness and stinging during sex or when you wee

More discharge than usual is normal in pregnancy. It’s the change to thick, white discharge, together with itching or soreness, that points to thrush. If your discharge smells fishy, is green, yellow or frothy, or comes with pain or bleeding, it’s more likely to be something else, such as bacterial vaginosis (BV) or an infection that needs a test. Our guide to discharge in early pregnancy explains what’s normal.

Is thrush harmful in pregnancy?

The NHS says there’s no evidence that thrush can harm an unborn baby. It’s still worth treating, because it can be very uncomfortable, and the bumps service (UK Teratology Information Service) notes that some studies have linked untreated thrush with a higher chance of premature birth, although this hasn’t been proven.

Which thrush treatments are safe in pregnancy?

See your GP or midwife before using any thrush treatment while you’re pregnant, even if you’ve had thrush before and recognise it.

Use a cream or pessary. In pregnancy, thrush is treated with a cream, or a tablet you put into your vagina (a pessary), containing clotrimazole or a similar antifungal. Clotrimazole is the first-choice treatment in pregnancy (UKTIS), and only very small amounts reach the baby. Check with your GP, midwife or pharmacist first.
A longer course is usually advised. UK sexual health guidelines recommend a longer course in pregnancy than the single dose many people use, usually a clotrimazole pessary at night for up to 7 nights.
Don’t take fluconazole tablets. Fluconazole is the tablet or capsule normally used for thrush, but the NHS says not to take it if you’re pregnant. Some studies have linked fluconazole in early pregnancy with a higher chance of miscarriage, and a slightly higher chance of rare heart problems in the baby, so it’s normally only used in pregnancy if other treatments haven’t worked.

Pessaries often come with an applicator, but don’t use it while you’re pregnant. Wash your hands and put the pessary in with your finger instead.

Thrush should clear up within 7 to 14 days of starting treatment. Antifungal creams can damage condoms and diaphragms, so they may not work as contraception while you’re using them.

If you’ve already taken fluconazole

Try not to panic, especially if you took it before you knew you were pregnant. Tell your GP or midwife, who can look at the details of your situation with you.

Thrush that keeps coming back

Thrush is usually called recurrent if you get it 4 or more times in a year. In pregnancy, see your GP or midwife if it keeps coming back or treatment hasn’t worked. Poorly controlled diabetes can make thrush more likely, so they may want to check for it, or refer you to a sexual health clinic.

How to help prevent thrush

Wash the area with water and an emollient instead of soap, and dry it well.
Wear cotton underwear, and avoid tight underwear or tights.
Don’t use soaps, shower gels, douches or deodorants on your vagina.
Avoid perfumed soap and perfumed bath products.
If sex is uncomfortable, it’s fine to wait until the thrush has cleared.

Can my baby get thrush?

If you have thrush when your baby is born, they may catch it during the birth. The NHS says this is nothing to worry about and can easily be treated.

Thrush in babies usually shows up in the mouth. Look out for:

a white coating on the tongue, which may look like cottage cheese
white spots or patches in the mouth that don’t rub off easily
not wanting to feed, or a nappy rash that won’t clear

Oral thrush is common: about 1 in 7 babies get it at some point. See a GP if your baby is under 4 months old and has signs of it. Mouth gels from a pharmacy are only for babies over 4 months.

If you’re breastfeeding, thrush can pass between your baby’s mouth and your nipples. Signs include sore, red, shiny or itchy nipples, or a burning or shooting pain in your breast during or after feeds. You and your baby will usually both need treating at the same time so you don’t keep passing it back and forth. Contact your midwife, GP or NHS 111 if you have pain in your breast or nipple that doesn’t go away.

Questions people ask

Can I buy thrush cream from a pharmacy when I’m pregnant?

Pharmacies sell clotrimazole creams and pessaries, but in pregnancy they should only be used with advice from a doctor or midwife. So see your GP or midwife first, even if you’ve had thrush before. Don’t buy thrush tablets or capsules (fluconazole), as they’re not suitable in pregnancy.

Can I have sex if I have thrush?

Sex can be sore when you have thrush. It’s fine to avoid sex until it clears, and remember that antifungal creams can weaken condoms.

Does thrush mean I have gestational diabetes?

Not necessarily. Poorly controlled diabetes is one of several things that make thrush more likely, and pregnancy itself is another. If it keeps coming back, mention it to your GP or midwife.

When to get help

Call your midwife if you have discharge that smells unpleasant, is green or yellow, makes you itchy or sore, or comes with pain when you wee. Contact your midwife or doctor straight away if you have any vaginal bleeding while you’re pregnant. If you think your waters have broken, call your maternity unit straight away.