Bacterial Vaginosis During Pregnancy
The short answer
Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance in the natural bacteria of the vagina. It affects up to 30% of pregnant people. BV during pregnancy has been associated with increased risk of preterm birth and premature rupture of membranes, so it is important to be treated if diagnosed.
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By Age
What to expect by age
BV can occur at any time during pregnancy. Symptoms include thin, grayish-white vaginal discharge with a strong fishy odor, especially after intercourse. Some people have no symptoms at all. If you notice unusual discharge, tell your provider. Treatment with pregnancy-safe antibiotics (oral or topical metronidazole or clindamycin) is recommended.
BV that is detected and treated reduces the risk of associated complications. Avoid douching, use only water to clean the vulvar area, wear cotton underwear, and avoid scented products in the vaginal area. BV is not considered a sexually transmitted infection but can be triggered by changes in vaginal flora.
Untreated BV in the third trimester may increase the risk of preterm premature rupture of membranes and preterm labor. If you develop symptoms, report them promptly. Treatment is safe and effective at this stage. BV can recur, so tell your provider if symptoms return.
What Should You Do?
When to take action
- Increased clear or white vaginal discharge without strong odor is normal in pregnancy
- Mild changes in discharge consistency are expected during pregnancy
- Thin, grayish-white discharge with a noticeable fishy smell
- Vaginal burning or itching with unusual discharge
- Any change in discharge color, consistency, or odor
- Discharge accompanied by pelvic pain, fever, or contractions
- Heavy watery discharge that could be amniotic fluid rather than vaginal discharge
Sources
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Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Maternal Concerns
Yeast Infections During Pregnancy
Yeast infections are more common during pregnancy due to higher estrogen levels and changes in vaginal pH that promote Candida overgrowth. They affect about 1 in 4 pregnant people. While uncomfortable, yeast infections do not harm the baby during pregnancy. Topical antifungal treatments are safe and effective during pregnancy.
Normal Vaginal Discharge Changes in Pregnancy
Increased vaginal discharge (leukorrhea) is a normal and expected change during pregnancy. It is typically thin, white or clear, and mild-smelling. This increased discharge helps protect the birth canal from infection and maintains a healthy balance of bacteria. Changes in color, odor, or consistency may indicate an infection and should be evaluated.
Preterm Labor Signs
Preterm labor is labor that begins before 37 weeks of pregnancy and affects about 10% of pregnancies. Recognizing the signs early is critical because treatment can often delay delivery, giving the baby more time to develop. Signs include regular contractions, lower back pain, pelvic pressure, vaginal discharge changes, and fluid leaking. Contact your provider immediately if you suspect preterm labor.
Dealing with Abnormal Prenatal Screening Results
An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.
Pregnancy Over 35 (Advanced Maternal Age)
While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.
Amniocentesis Questions and Fears
Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.