How to Fix pH Balance While Pregnant

Pregnancy brings about a lot of changes to your body, many of which are expected. Hormonal shifts, a growing baby bump, and even some strange cravings are all part and parcel of pregnancy. One important change that flies under the radar during this time is an imbalanced vaginal pH. 

For people who are pregnant, understanding these changes can be key to preventing discomfort, reducing infection risk, and supporting overall reproductive health. It’s also important to recognize that not all treatments for vaginal pH imbalance are safe during pregnancy. While some approaches can help restore balance without posing risks, others — especially certain medications or untested supplements — may not be suitable. Keep reading to learn what’s safe and evidence-based for restoring vaginal pH balance during pregnancy.

What is vaginal pH?

Vaginal pH is a measure of how acidic or basic the vaginal environment is. A healthy vaginal pH is slightly acidic, typically between 3.8 and 4.5. This acidic environment is maintained by the dominance of certain beneficial bacteria, most notably Lactobacillus species. These bacteria produce lactic acid, which helps protect the vagina from pathogens by keeping the pH low.

When vaginal pH becomes elevated, the balance is thrown off. This can create an environment where harmful bacteria are more likely to thrive, increasing the risk of conditions such as bacterial vaginosis (BV), aerobic vaginitis (AV), and yeast infections. While mild fluctuations in pH are normal, persistent elevation during pregnancy can be a sign of dysbiosis, or microbial imbalance.

How pregnancy affects vaginal pH

Pregnancy introduces a cascade of hormonal, metabolic, and microbial changes that can all influence vaginal pH. These changes are often adaptive, designed to protect the uterus and the developing fetus. However, they can also predispose some individuals to vaginal pH imbalance.

Interestingly, research shows that vaginal pH often decreases at the start of pregnancy. The main cause of this change is the increase in estrogen levels. Higher estrogen causes more glycogen to build up in the vaginal lining. This glycogen serves as food for Lactobacillus bacteria, which then produce more lactic acid. This process helps keep the vaginal pH low. In most healthy pregnancies, this change improves the vagina’s natural defenses.

However, this isn’t always the case. In pregnant individuals with obesity, for example, estrogen levels produced by the placenta may be lower, and glycogen metabolism may be altered. These factors can lead to a higher vaginal pH and increased microbial diversity, which are both signs of dysbiosis. The outcome is a less acidic environment, which can compromise the protective barrier provided by a Lactobacillus-dominant microbiome.

Other factors that can elevate vaginal pH during pregnancy include sexual activity, especially when semen is introduced into the vagina. Semen has a naturally higher pH, and though its impact is usually temporary, repeated exposure can contribute to longer-term imbalance. Additionally, antibiotics prescribed during pregnancy can disrupt the vaginal microbiota, diminishing Lactobacillus populations and raising pH levels.

Signs of an imbalanced vaginal pH during pregnancy

An imbalanced vaginal pH may not always be immediately obvious, but there are some common signs and symptoms that pregnant individuals should be aware of:

• Unusual vaginal discharge (especially thin, gray, or greenish)
• A fishy smell or foul odor
• Vaginal itching or irritation
• A burning sensation when you pee
• Increased susceptibility to infections. 

It’s worth noting that these symptoms can also be associated with other conditions, so it’s always best to see a healthcare provider for a proper diagnosis.

How to restore pH balance during pregnancy

Fortunately, there are several safe and evidence-based ways to restore vaginal pH balance during pregnancy. The primary goal of all treatments is to re-establish a Lactobacillus-dominant environment, which naturally maintains a pH below 4.5 and protects against harmful microbes.

Antibiotics

Antibiotics can play an important role in treating bacterial infections that affect vaginal health, but they come with trade-offs. While effective at eliminating pathogenic bacteria, they often disrupt the beneficial Lactobacillus-dominant microbiota, leading to elevated vaginal pH and increased risk of recurrent dysbiosis.

That said, certain antibiotics are considered safe and appropriate for use during pregnancy, especially when infections pose a risk to the mother or fetus. According to the Centers for Disease Control and Prevention (CDC), the antibiotics considered safe for treating vaginal infections in pregnancy — particularly those affecting vaginal pH and microbiome — include metronidazole and clindamycin. The CDC doesn’t recommend using tinidazole or other less-studied medications like secnidazole and some topical antibiotics during pregnancy because there isn't enough safety data. 

Although antibiotics can upset the balance of good bacteria in the vagina and raise pH levels, they’re necessary for treating infections. Untreated infections can lead to more serious problems for both the pregnant person and the fetus.

Using antibiotics, taking vaginal probiotics, or using buffering gels can help restore an acidic pH level and support the growth of Lactobacillus bacteria. Always talk to a healthcare provider before starting or stopping any antibiotics during pregnancy, or using any probiotics or buffering gels.

Probiotics 

One strategy for supporting vaginal health during pregnancy involves the use of probiotics containing specific Lactobacillus strains. These healthy bacteria play a key role in maintaining an acidic vaginal environment, which helps protect against infections and promotes a stable microbiome.

It’s important to note, however, that probiotics aren’t a treatment for active infections like bacterial vaginosis or yeast infections. Instead, they’re best used as a preventive tool to help maintain vaginal health or restore a healthy microbial balance, especially after disruptions from factors like antibiotics, hormonal shifts, or sexual intercourse.

Studies have shown that oral and vaginal probiotics containing Lactobacillus can help restore a balance of vaginal flora, and prevent BV recurrence. However, there are fewer studies in pregnant women.

Probiotic supplements are generally considered safe during pregnancy when used as directed. However, not all formulations are equally effective. Look for products that contain well-studied strains like Lactobacillus rhamnosus and Lactobacillus reuteri, such as Evvy Women’s Complete Probiotic. 

Designed for anyone with a vagina, it’s formulated with clinically-studied Lactobacillus strains carefully selected for women’s interconnected microbiomes. It also includes postbiotics and targeted vitamin D3 & E to support immune health and gut barrier protection.

If you’re looking to support your vaginal, gut, and urinary tract health throughout pregnancy and beyond, the Evvy Women’s Complete Probiotic offers a research-backed daily option. As always, consult your healthcare provider before starting any new supplement, especially if you’re pregnant or nursing. But again, always consult with your pregnancy healthcare provider before starting any probiotics.

Vaginal gels

Buffering gels are designed to restore the acidic pH of the vagina and have been effective during pregnancy. You usually apply these gels every few days for several weeks. They work by lowering pH and soothing irritation.

Clinical trials show that using these gels consistently can help reduce vaginal inflammation, as shown by lower levels of IL-6, a marker of inflammation. They also support the growth of healthy vaginal flora. These gels are generally well-tolerated and provide a non-antibiotic option for mild dysbiosis. Ph-balancing vaginal gels are an accessible over-the-counter option, but it's always best to see your healthcare provider if you suspect you have a vaginal infection. They may recommend prescription treatment to fully target the infection. 

Use condoms

It might feel unnecessary to use condoms when you're already expecting, but they do much more than prevent pregnancies. Chiefly, condoms protect you against both vaginal infections and sexually transmitted infections (STIs), both of which can be dangerous in pregnancy.

Unprotected sex can have a notable impact on vaginal pH because semen naturally has a higher, more alkaline pH (typically around 7.2 to 8.0) compared to the normally acidic vaginal environment. When semen enters the vagina during sex, it temporarily raises the vaginal pH, making the environment less acidic. This shift can disrupt the balance of the vaginal microbiota, especially the beneficial Lactobacillus species that thrive in an acidic environment and help keep harmful bacteria in check. Frequent or repeated exposure to semen without protection can therefore increase the risk of dysbiosis, creating favorable conditions for infections such as bacterial vaginosis or yeast overgrowth.

During pregnancy, maintaining a stable vaginal pH is particularly important since infections can increase the risk of complications for both the parent and the baby. Because unprotected sex can cause repeated fluctuations in vaginal pH, it may contribute to episodes of dysbiosis or microbial imbalance, potentially increasing the likelihood of inflammation or infection.

Using condoms during sex is a simple and effective way to prevent these pH changes. Condoms act as a barrier, preventing semen from entering the vagina and thus helping maintain the natural acidic environment that supports a healthy vaginal microbiome. By minimizing the disruption to vaginal pH, condom use reduces the risk of bacterial imbalances and infections. For pregnant individuals or those trying to maintain vaginal health, consistent condom use during intercourse can be an important preventive measure to help keep the vaginal environment stable and balanced.

What to avoid

While it can be tempting to try over-the-counter products or home remedies, there are a few treatments best avoided during pregnancy.

Douching, for example, is strongly discouraged. It can strip away healthy bacteria and worsen pH imbalance. Similarly, many over-the-counter vaginal cleansers and deodorants contain fragrances and harsh chemicals that can disrupt the vaginal microbiome.

Another popular treatment to avoid is boric acid suppositories. Boric acid is a mild antiseptic often used to treat certain vaginal infections, such as vaginal yeast infections or bacterial vaginosis, especially when other treatments haven’t worked. It helps restore the natural acidity of the vagina, creating an environment less favorable to harmful microbes. However, boric acid isn't considered safe during pregnancy because there's insufficient evidence about its safety for the developing baby. For this reason, pregnant individuals should avoid using boric acid and consult their healthcare provider for safer treatment options.

At-home or “natural” remedies, such as inserting garlic, yogurt, or apple cider vinegar, may be widely recommended on social media or wellness blogs, but they’re not backed by clinical research and can be unsafe, especially during pregnancy. Inserting unproven substances into the vagina introduces a risk of irritation, infection, or unintended side effects that could affect both you and your baby.

Pregnancy is a time when vaginal infections carry higher stakes, including increased risk for complications like preterm labor, low birth weight, or uterine infection if left untreated. That’s why it's so important not to rely on pantry items or anecdotal advice. 

If you’re experiencing any symptoms of imbalance, such as unusual discharge, odor, itching, or irritation, the safest and most effective step is to consult a healthcare provider. They can determine the cause and recommend evidence-based treatments that are appropriate for pregnancy.

The importance of individualized care

No two pregnancies are the same, and the same goes for vaginal health. When considering treatment options for pH imbalance, it’s important to factor in individual risk factors, symptom severity, and overall health. For example, someone with obesity or a history of recurrent BV may benefit from a different treatment strategy than someone experiencing their first episode of imbalance.

Regular prenatal care is a crucial part of identifying and managing vaginal health concerns. Many providers can perform pH testing, microbial analysis (e.g., Amsel Criteria), and help determine the best course of action.

FAQ

How can I get my pH balance back to normal?

The first step to getting your vaginal pH back to normal during pregnancy is getting an accurate diagnosis. If you're experiencing symptoms like unusual discharge, odor, or irritation, it's important to see a healthcare provider who can determine whether there’s an infection such as bacterial vaginosis or aerobic vaginitis. If needed, they can prescribe safe and effective treatments, like metronidazole or clindamycin, which are both recommended by the CDC during pregnancy. Once any infection is treated, supporting a healthy vaginal environment is key. While probiotics can’t cure infections, formulations with specific Lactobacillus species may help restore balance and prevent future disruptions. Some pregnant individuals may also benefit from pH-balancing gels. Avoid at-home or natural remedies, which often lack scientific support and could worsen the issue. The safest path is always through accurate diagnosis and evidence-based care.

Is it normal for your pH balance to be off during pregnancy?

Yes, it's normal for the vaginal pH balance to change when you're pregnant, but it depends on what that shift is. Hormonal shifts lead to changes in the vaginal environment, making it more acidic and favoring Lactobacillus bacteria. However, these changes can vary among different women. Studies show that many women keep a stable, acidic vaginal pH during pregnancy, but many also experience changes in pH, especially in the first trimester or when there is bad bacteria present.

Is it safe to take pH balance pills while pregnant?

The safety of over-the-counter pH balance pills or supplements that aim to restore vaginal pH during pregnancy isn't well studied. Because pregnancy is a sensitive time, these supplements aren't usually recommended. It's important to maintain a Lactobacillus-dominant vaginal environment for good vaginal health and positive pregnancy outcomes. However, the evidence on how effective and safe oral pH balance supplements are during pregnancy is limited and inconsistent. You should always talk to your healthcare provider before starting any new supplements or treatments while pregnant. Your provider can help you find safe and effective options based on your needs and ensure the health of both you and your baby.