Bacterial Vaginosis While Pregnant

Bacterial vaginosis is a common infection during pregnancy. It affects an estimated 30% of pregnant women every year. This infection occurs when there is too much of a certain bacteria in the woman's vagina. Pregnant women are at an increased risk of contracting this infection due to the fluctuation of hormones happening in their bodies.

Bacterial vaginosis is not a sexually transmitted infection, contrary to popular belief. But a vaginosis infection is much more common in sexually active women. In most cases, bacterial vaginosis can be cured with a standard course of antibiotics.

But untreated bacterial vaginosis can lead to pregnancy complications. Bacterial vaginosis can lead to spontaneous abortion (especially with IVF) and early delivery. Studies have indicated that bacterial vaginosis may increase the risk of premature birth. A comprehensive review from 2007, which analyzed 32 studies, estimated that the likelihood of premature delivery with undetected bacterial vaginosis was about 2.16 times higher. 

So a bacterial vaginosis pregnancy increases the risk to the fetus and the mother. The take-home message is that while most likely your infection will not harm you or your baby, you should take bacterial vaginosis during pregnancy seriously. 

Pregnant Woman Holding Hands with her HusbandBacterial

Bacterial vaginosis was once named Gardnerella vaginitis. This is because of a belief that this was the bacterium that led to BV. The new name there is like many different types of bacteria that are in the vagina. There is nothing wrong with these bacteria typically. But if they quickly multiply, they can cause BV.

What is Bacterial Vaginosis?

Bacterial vaginosis is an infection that causes inflammation of the vagina. Bacteria is not always a bad thing. The vagina is filled with naturally occurring bacteria that helps keep its pH balanced. When there is an overgrowth of the vagina's "bad" bacteria, it upsets the natural balance and starts to cause problems.

The cause of BV is not fully understood yet but is associated with having sex or frequent douching. Women who don't have sex rarely contract this infection. The hormones in a pregnant woman's body can make it easier for bacteria to collect in the vagina. Increased hormone production and its fluctuations make it difficult for the vagina to keep its pH balanced.

Symptoms of BV

Many women with BV do not exhibit any symptoms, which can make it harder for pregnant women to identify if they have an infection. Symptoms of BV include:

  • Thin vaginal discharge
  • Discharge that is gray, white, or green
  • Foul-smelling or "fishy" vagina odor
  • Vaginal itching
  • Pain in the vagina
  • Burning during urination
  • Burning feeling inside the vagina

If you start showing signs of BV, it's important to contact your health provider as soon as possible to prevent any complications.

Causes and Risk Factors for Bacterial Vaginosis?
The vagina houses a complex community of bacteria that play a role in its overall health. Not all bacteria is bad. In a healthy vagina, the dominant bacteria are of the lactobacilli species, which produce lactic acid, keeping the vagina's pH level slightly acidic. This acidic environment prevents the growth of harmful bacteria.

Bacterial vaginosis arises when the the balance of the apple cart is upset. So when bad bacteria outnumbers the good guy lactobacilli, the pH level of the vagina rises, leading to symptoms of bacterial vaginosis. What is the exact cause of the imbalance?  It is not always easy to know in individual patients. And usually doctors do not care, they just want to solve the problem. 
How Does Bacterial Vaginosis Affect My Pregnancy?

It's estimated that 1 million pregnant women contract BV every year. In the majority of cases, the infection can be successfully treated and there are no adverse effects for the baby. BV that is not detected early or is left untreated increases the risk of premature birth and low birthweight. Some studies have also shown that BV is linked to miscarriage and premature rupture of the membranes.

There are real practical consequences with a bacterial vaginosis pregnancy.  When a baby is born too early or has a low birth weight, it puts them at risk for several different complications, including underdeveloped organs, infections, lower Apgar scores, jaundice, and brain hemorrhaging. The more premature a baby is, the more likely they are to develop problems after birth.

Premature rupture of the membranes (PROM) is when the mother's amniotic sac ruptures before labor begins. PROM increases the risk of chorioamnionitis (infection of the placental tissues), compression of the umbilical cord, and cesarean birth. BV can also lead to pelvic inflammatory disease (PID), which is an infection of the uterus and fallopian tubes. PID is known to cause infertility.

Diagnosis and Treatment for Bacterial Vaginosis

If you suspect you have BV, there are different ways a doctor can diagnose the conditions. First, the doctor may ask questions about your medical history. Previous vaginal infections of STIs can increase the risk of getting BV. A pelvic examination is usually performed to inspect the inside of the vagina for signs of infection. The doctor will insert two fingers into the vagina while pressing on the abdomen with their other hand to check for signs of inflammation or infection in your pelvic organs.

During the pelvic exam, the doctor collects a sample of vaginal secretions. The secretion is tested under a microscope for an overgrowth of bacteria. Finally, the doctor may also test your vaginal ph or the acidity of your vagina. This involves placing a small pH test strip inside your vagina. A pH of 4.5 or higher is an indication of infection.

Once the diagnosis is confirmed, antibiotics are prescribed to cure BV. Common antibiotics used during treatment include metronidazole, clindamycin, and tinidazole. You may be given a combination of oral pills and topical creams. The pills are used to get rid of the infection, while topical cream can be used inside and around the vagina to relieve some of the immediate symptoms.

If you have BV, make sure to finish the entire course of antibiotics, even if you're not experiencing any more symptoms. Antibiotics that are stopped early can allow a recurrence of the infection that becomes more resistant to typical treatment. Male partners of women with BV generally do not need to be treated, but the infection can spread between female sexual partners. Avoid having sex until treatment is finished to prevent further irritation.

It's normal for pregnant women to get multiple bacterial vaginosis infections throughout gestation. Hormones will continue to rise and fluctuate until after birth, which causes the natural balance of bacteria to be continuously disrupted. This can be frustrating, especially when you're experiencing uncomfortable symptoms, but BV must be treated every time to keep your baby safe.

Risk Factors of BV

Besides being pregnant, other risk factors increase your chances of getting BV. These include:

  • Having multiple sex partners or a new sex partner: Even though the cause of BV is unknown, the infection is linked to sexual activity. BV is more common in women who have sex with other women.
  • Douching: This practice involves rinsing out the inside of the vagina with water or other cleansing liquid, which can upset your vagina's bacterial balance and pH. Douching is known to increase the risk of BV. Women are generally discouraged to use a douche since the vagina is already self-cleaning.
  • Lacking certain bacteria: Some women's bodies do not produce enough of the "good" bacteria in the vagina, making it easier to cause infection.
  • Are African-American: African-American women are twice as likely to contract BV than white women. The cause for this is not fully understood.
  • Intrauterine devices (IUDs): Some women with a copper IUD like Paragard may be at a higher risk, though research. But there is research going both ways on this is inconclusive.
  • Natural lack of lactobacilli: Some women naturally don't produce as many lactobacilli bacteria.
Preventing BV Infections

Fortunately for pregnant women, there are ways you can help prevent BV.

  • Avoid having sex often
  • Avoid further irritation of the vagina
  • Limit the number of sexual partners
  • Do not douche
  • Use only warm water to clean the outside of the vagina
  • Use gentle, fragrance-free soaps
  • Use a condom during sex
  • Avoid contracting an STI
  • Get regularly screened for BV

Even if you try all these methods, some pregnant women will still face recurrent bacterial vaginosis during pregnancy.  Unfortunately, infections around the pelvic region are extremely common during pregnancy. BV can be frustrating.  But it is generally is not a cause for concern as long as it's treated properly. Early detection and the use of antibiotics can reduce the risk of harm from bacterial vaginosis during pregnancy.  So if you start experiencing symptoms of BV, do not wait to contact your doctor.