A woman’s body goes through many physical and hormonal changes during pregnancy, as we discuss here. Some of these changes are expected, but others may come as a surprise. Changes in vaginal discharge are common during pregnancy. These changes are rarely discussed openly and can be confusing to pregnant women.
What is normal?
Some vaginal discharge is expected during a normal menstrual cycle. As we explain here, discharge is released due to changes in hormone levels. Normal vaginal discharge is called leukorrhea and is thin, milky white or clear, and has little to no odor (1). Leukorrhea is healthy, because it reduces the chances that harmful bacteria can grow in the vaginal area. Most women report an increased amount of discharge during pregnancy, as estrogen and vaginal blood flow increase. This increase in discharge usually becomes noticeable during the first trimester and continues to increase throughout pregnancy, reducing the risk of vaginal infections. Some women report increased discharge as a first sign of pregnancy, but as we explain here, this discharge usually appears in the second or third month, or after a pregnancy test would show a positive reading. Discharge can also be present even if a normal period is about to occur, so it is not a reliable indicator of pregnancy. During the last trimester, discharge may become heavier and thicker, and it may look slightly pink in the days immediately before labor. These changes are due to the release of the cervical mucus plug, which protects the uterus and developing baby from bacteria during pregnancy. All of these changes in discharge are normal for a healthy pregnancy.
What is abnormal?
Changes in the color, texture, itchiness, or odor of discharge may signal a problem and should be further evaluated. Yeast infections, especially candidiasis, are common during pregnancy. The hormonal changes that happen during pregnancy increase the risk of developing yeast infections (2). Yeast infections cause vaginal itchiness and burning, as well as discharge that looks lumpy and white, like curd or cottage cheese (3). Luckily, there are fungal treatments available. These treatments reduce the risk of problems, including pre-term birth or exposure of the newborn to yeast during vaginal delivery, which can cause oral thrush.
Sexually transmitted infections (STIs) are another cause of vaginal discharge (3). Discharge because of STIs is usually green or yellow. Common types of STIs during pregnancy are chlamydia and trichomoniasis. Although there is sometimes itchiness or redness, STIs often have no other symptoms other than the odd-colored discharge. The effects of STIs on maternal and neonatal health vary, but some STIs can cause preterm labor or long-term health problems for newborns (4). Medical follow-up makes a difference, because many STIs can be safely treated with antibiotics during pregnancy. Similar to STIs, bacterial vaginosis is associated with sexual activity with multiple partners in women of child-bearing age. Pregnancy further increases the risk of bacterial vaginosis. As we explain here, as many as one-third of pregnant women may develop this infection. Gray vaginal discharge with a fishy odor may indicate bacterial vaginosis. Oral antibiotics are available to treat this infection and can help reduce the risk of premature birth or miscarriage (5).
Many women become concerned when they see pink discharge or spotting. However, spotting occurs in about 20% of women during early pregnancy (6), and is often not a cause for concern, as we discuss here. Most women who have early and brief spotting do fine and continue on with healthy pregnancies. However, if pink or red discharge persists, or is accompanied by pain or cramping, consult a healthcare provider for follow-up. Additional information about spotting and bleeding during pregnancy can be found here.
Vaginal discharge that appears very watery and has no odor may be leaking amniotic fluid. There are medical approaches to help reduce loss of amniotic fluid, so a physician should be consulted.
Strategies for vaginal health
During pregnancy, there are many steps that women can take to improve their vaginal health and reduce risk of infections and discomfort from discharge. Pregnant women should not douche or use tampons, as these can alter the environment of the vaginal area, making it easier for harmful bacteria to thrive. Keeping the area dry by wearing cotton underwear and panty liners will also help. Unscented soaps or body washes can help limit itchiness, with is sometimes associated with fragrances. Although there are suggestions that probiotic foods or supplements may help maintain a healthy environment, there is no conclusive evidence. Regardless, eating a nutritious, balanced diet can help maintain overall health, including in the vaginal environment, during pregnancy.
- American Pregnancy Association, Vaginal discharge during pregnancy.
- Gonçalves et al. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Critical Reviews in Microbiology 2016;42:905-27.
- Medical News Today, What do different colors of discharge mean in pregnancy?
- Centers for Disease Control and Prevention, STDs during pregnancy fact sheet.
- Reiter and Spadt. Bacterial vaginosis: a primer for clinicians. Postgraduate medicine 2019;131:8-18.
- American Pregnancy Association, Spotting during pregnancy.