Bacterial vaginosis (BV) is a common vaginal infection resulting from an imbalance in the naturally occurring bacteria within the vagina. This article explores the relationship between BV and potential pregnancy complications, specifically miscarriage and other adverse outcomes. Understanding this connection can help pregnant individuals and their healthcare providers make informed decisions for a healthy pregnancy.
Understanding Bacterial Vaginosis
Bacterial vaginosis (BV) results from a disrupted balance of vaginal microorganisms, specifically an overgrowth of certain anaerobic bacteria and a decrease in beneficial lactobacilli that normally maintain a healthy vaginal environment. Factors that can alter the vaginal microbiome include douching, having new or multiple sexual partners, and a natural lack of lactobacilli. Hormonal changes during pregnancy can also increase susceptibility to BV.
Many individuals with BV experience no symptoms, making it a silent condition. When symptoms are present, they may include an unusual vaginal discharge that is off-white, gray, or greenish, often thin and watery. A strong “fishy” odor, which can become more noticeable after sexual intercourse, is common. Other symptoms include vaginal itching or a burning sensation during urination.
How BV Can Affect Pregnancy Outcomes
Bacterial vaginosis increases the risk of adverse pregnancy outcomes, including miscarriage. Studies suggest a twofold to threefold increased risk of miscarriage, particularly in the first or second trimester, for pregnant individuals with BV. This heightened risk is primarily due to the inflammatory response triggered by the bacterial imbalance. The overgrowth of certain bacteria can lead to inflammation of the amniotic membranes and the release of inflammatory chemicals, such as cytokines and prostaglandins.
These inflammatory mediators can weaken the protective membranes surrounding the fetus, potentially leading to premature rupture of membranes. They can also stimulate uterine contractions, contributing to preterm labor or early pregnancy loss. While BV is considered a risk factor, many pregnant individuals diagnosed with BV carry their pregnancies to term without complications. However, untreated BV can also be linked to other complications such as preterm birth, low birth weight, and chorioamnionitis, an infection of the amniotic fluid and membranes.
Diagnosis and Treatment of BV in Pregnancy
Diagnosing bacterial vaginosis during pregnancy involves a pelvic examination and laboratory tests of vaginal fluid. Healthcare providers may perform a microscopic examination of vaginal fluid for “clue cells” and assess vaginal pH, which is often elevated in BV. A “whiff test,” which detects a strong, fishy odor, also aids in diagnosis. A Gram stain is considered a reference standard for diagnosis.
If BV is diagnosed, treatment is recommended for pregnant individuals, especially those experiencing symptoms or with a history of preterm labor, to reduce potential complications. Treatment involves antibiotics, prescribed as oral medications or vaginal creams or gels. Commonly prescribed antibiotics include metronidazole and clindamycin, considered safe during pregnancy when taken as directed. It is important to complete the full course of medication, even if symptoms improve, to ensure the infection is fully cleared.
Steps for a Healthy Pregnancy
Maintaining a healthy pregnancy involves several measures to reduce the risk of conditions like bacterial vaginosis. Practicing safe sex, including consistent use of condoms and limiting the number of sexual partners, can help minimize exposure to factors that disrupt vaginal flora. Avoiding douching is also recommended, as it can upset the natural bacterial balance in the vagina. Choosing breathable cotton underwear and maintaining good personal hygiene can further support vaginal health.
Regular prenatal care is important throughout pregnancy, allowing for consistent monitoring and early detection of any potential issues. Open communication with a healthcare provider about any unusual symptoms, such as changes in vaginal discharge or odor, is encouraged. Seeking prompt medical attention if symptoms of BV or any other pregnancy concerns arise allows for timely diagnosis and treatment, which can significantly reduce potential risks for both the pregnant individual and the baby.