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Nipple candidiasis among breastfeeding mothers. Case-control study of predisposing factors
K E Tanguay1, M R McBean, E Jain
1Department of Family Medicine, University of Calgary.
Objective:
To investigate factors that predispose breastfeeding mothers to nipple candidiasis.
Design:
A retrospective case-control study of women attending the Calgary Breastfeeding Clinic.
Setting:
Ambulatory breastfeeding referral centre.
Participants:
All women (105) who attended the clinic during a 3.5-month study period. All were referred for problems with breastfeeding; 27 (the case group) had positive diagnostic criteria for nipple candidiasis. The other 78 formed a control group.
Main Outcome Measure:
A patient information sheet, completed while taking a medical history, recorded the presence or absence of four possible predisposing factors. Two infant variables were also noted on physical examination. Patients were diagnosed as having or not having nipple candidiasis on the basis of specific clinical criteria, and statistics on other variables were compared for those with positive and with negative diagnoses.
Results:
A statistically significant correlation (P < 0.05) was found between nipple candidiasis and three factors: vaginal candidiasis (P = 0.001), previous antibiotic use (P = 0.036), and nipple trauma (P = 0.001).
Conclusions:
Further research is required to establish clear causality. However, we recommend that physicians be suspicious of nipple candidiasis; avoid antibiotics or use the shortest effective course; treat yeast vaginitis during the third trimester and after delivery aggressively; and treat mothers for nipple yeast if babies have oral or diaper candidiasis. Breastfeeding mothers can also be counseled in preventive measures.