Bacterial Vaginosis during first trimester of pregnancy

[Avusingh]

I am 12 weeks pregnant with my first child. I have a recurrent history of Bacterial Vaginosis and I get it every 2-3 months. During the 8th week of pregnancy I contracted it again. My Ob/Gyn prescribed me Oral Clindamycin for 7 days (300 mg capsules twice daily). I took the medication but went back to my Ob/Gyn as the infection continued. She prescribed me 2% Clindamycin Vaginal cream for 7 days, but the infection still persisted. My Ob/Gyn asked me to wait 3-4 days so that my vagina was clear of the medicine so that she could draw samples to see how the infection was progressing. When I went back, she did tests and said that my infection was still continuing, though the pH was in the normal range. This time she prescribed Metronidazole vaginal cream for 5 nights and said that since this is a very recurrent infection, I needed a comprehensive treatment. In order to do this, she recommended that I use just one applicator of Metronidazole vaginal cream at night every week for the next 2 months so that the infection is under control and does not recur. I have the following questions about the effect my infections and treatments can have on my baby: A) Since I got the infection in the first trimester, does treating it with Clindamycin (oral and Vaginal) drug result in any kind of problems for the baby? B) How do anti-biotics effect the growth of the fetus? C) I have read that Bacterial Vaginosis results in second trimester miscarriages/preterm labor. What are the chances of having such miscarriages?  D) Is using the Metronidazole vaginal cream during the second trimester acceptable? Are there any problems that can happen with the child due to using this medication? E) About the comprehensive treatment, given that I do have a history of this infection, does it look like an effective way of treatment? F) Are there any other treatments/precautions that I should be taking to help reduce the effect of this infection and its treatment on my baby?

[Alison L, RPh]

A. Oral clindamycin has been proven to be safe in pregnant women. The CDC recommends intravaginal clindamycin cream should only be used during the first half of pregnancy.
B. Antibiotics given to pregnant women are studied carefully and have the least potential effects to the growth and development of  the baby.  
C. Bacterial Vaginosis can cause preterm labor and problems with fertility if it is not treated properly. If the infection isn’t treated properly, then you run the risk of the baby being born early.
D. There haven't been any studies done with metronidazole vaginal gel and pregnant women, however, your doctor may feel that the benefits of using this medication far outweigh any risks.
F. It is important to complete your therapy and length of treatment for metronidiazole even if you do start feeling better. The number one reason why reoccurrence happens is when patients feel better and do not complete their antibiotic therapy fully. As I mentioned before, the best way to keep your baby healthy and safe is to use the medication and complete your therapy. As long as the infection has been cured, you have a less chance of preterm labor and all the complications you are worried about. It is critical to get the infection under control as the doctor said.