Abstract: Objective To analyze the effect of Candida in different states on Toll-like receptor signaling pathway in peripheral blood of patients with vaginitis during pregnancy and its relationship with pregnancy outcome. Methods Candida isolated from patients with vaginitis during pregnancy was selected to construct a biofilm model in vitro. Crystal violet and fluorescence staining were used to legally observe the growth and morphology of the biofilm to find strong membrane-producing group and non-film production group. Then 178 healthy parturients were selected as the control group. RT-PCR method was used to detect the expression of TLR2, TLR4 and MyD88 genes in peripheral blood mononuclear cells of each group of patients; ELISA was used to determine the concentration of cytokines in each group, and statistical analysis of maternal premature delivery, abnormal amniotic fluid and premature rupture of membranes And other bad endings. Results A total of 178 Candida strains were isolated, including 64 strains with strong membrane production. The peripheral blood TLR2, TLR4 and MyD88 gene expression of this group of patients was lower than that of the control group, while the non-film production group was higher than the control group (P<0.05). Compared with the control group, the plasma levels of IL-1β, TNF, and IFN-γ in the strong membrane-producing group were significantly lower than those in the control group (P<0.05). The incidence of adverse pregnancy outcomes in the control group in the non-membrane group and in the strong membrane group were 2.8%, 4.3%, and 21.8%. The difference was statistically significant. Conclusion Pregnant women infected with Candida of strong membrane-producing group could down-regulate the expression of TLR2 and TLR4, resulting in a weakened cellular immune response and an imbalanced Th1/Th2 ratio, which might cause changes in the expression of cytokines and could also increase the risk of adverse pregnancy outcomes.

Key words: pregnancy, candida, biofilm, pregnancy outcomes