Efficacy and safety of intravaginal lactic acid use during pregnancy for the treatment of bacterial vaginosis
Kira E.F., Rastorgueva L.I., Apresyan S.V.
Bacterial vaginosis (BV) is one of the most common conditions associated with an imbalance in the vaginal microbiota in women of reproductive age. BV is a risk factor for miscarriage, preterm birth, postpartum endometritis, intrauterine infection of the fetus, and many other obstetric complications. Treatment of BV in pregnant women, particularly during the first trimester, presents certain challenges. The search for new ways to correct the vaginal microbiota is a priority area.
Objective: To conduct a comparative analysis of the clinical and laboratory efficacy and safety of treatment for primary BV in pregnant women, comparing 100 mg lactic acid vaginal suppositories with conventional therapy using antiseptics or metronidazole.
Materials and methods: An open-label, controlled, prospective cohort study was conducted to assess the efficacy, safety and tolerability of 100 mg lactic acid in the treatment of primary BV in pregnant women during the first, second and third trimesters. The study included 120 women divided into two representative groups. Group 1 comprised 70 patients who were treated for BV with 100 mg of lactic acid. Group 2 consisted of 50 pregnant women who were prescribed standard courses of antiseptics or a single-dose course of metronidazole.
Results: Thirty days after the end of treatment, normal vaginal acidity persisted in 98.7% of pregnant women in group 1, whereas in group 2 it persisted in only 44% (p<0.0001). One month after treatment, key cells were not detected in any of the patients in group 1. In the control group, they were detected in 56% of cases (p<0.0001). Similar positive dynamics was observed with regard to the aminotest: the absence of a sign was noted in group 1 and the presence of a sign was observed in 52% of patients in group 2. It has been established that treatment with lactic acid is more effective for BV than with antiseptics or antibiotics. The dynamics of changes in the vaginal microbiota in group 1 showed a significant increase in the number of lactobacilli across the trimesters of pregnancy: in the first trimester – from 105.21±2.02 to 106.58±0.72 (p=0.0051); in the second trimester – from 104.75±2.43 to 106.50±0.79 (p=0.0051) and in the third trimester – from 104.89±2.32 to 106.67±0.69. The increase was 26.4%, 36.84% and 36.36% in the first, second and third trimesters, respectively (p=0.0051). The analysis of the course of pregnancy, labor and the postpartum period showed better results in group 1.
Conclusion: Lactic acid (100 mg) in the form of vaginal suppositories is an effective and safe treatment for BV during pregnancy, including for pregnant women in the first trimester.
Authors’ contributions: Kira E.F. – developing the concept and design of the study, writing and final editing the article; Rastorgueva L.I. – conducting the clinical study, selecting the material about pregnant women, writing a section of the article, translating into English; Apresyan S.V. – co-principal researcher of the clinical study, editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest. Nizhpharm JSC provided support for writing the scientific text of the article. The views expressed by the authors may not coincide with the opinion of the company.
Funding: The study was conducted without sponsorship.
Ethical Approval: The research was approved by the Ethical Review Board of the Pirogov National Medical and Surgical Center, Ministry of Health of Russia.
Patient Consent for Publication: The patients provided an informed consent to the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Kira E.F., Rastorgueva L.I., Apresyan S.V. Efficacy and safety
of intravaginal lactic acid use during pregnancy for the treatment of bacterial vaginosis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (3): 125-135 (in Russian)
https://dx.doi.org/10.18565/aig.2026.81
Keywords
microbiota of the vagina
vaginal infections
bacterial vaginosis
lactic acid
pregnancy
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Received 05.03.2026
Accepted 25.03.2026
About the Authors
Evgeny F. Kira, Merited Scholar of the Russian Federation, Honored Doctor of the Russian Federation, Academician of the Russian Academy of Natural Sciences,Dr. Med. Sci., Professor, President of the All-Russian Public Organization Russian Association for Genital Infections and Neoplasia (RAGIN); Director General, Biom Technologies LLC, Moscow, +7(916)576-54-32, profkira33@gmail.com, https://orcid.org/0000-0002-1376-7361
Larisa I. Rastorgueva, Teaching Assistant at the Department of Women ‘s Diseases and Reproductive Health of the Institute of Medical Improvement, Pirogov National Medical and Surgical Center, Ministry of Health of Russia, 105203, Russia, Moscow, Nizhnyaya Pervomaiskaya str., 65; Head of Gynecological Department, Medical and Diagnostic Center Kutuzovsky, Moscow, +7(916)609-83-07, lara_rastor@mail.ru, https://orcid.org/0009-0001-6502-2409
Sergey V. Apreseyan, Dr. Med. Sci., Deputy Chief Physician for Obstetric and Gynecological Care, A.K. Eramishantsev City Clinical Hospital, Moscow Healthcare Department, 129327, Russia, Moscow, Lenskaya str., 15, +7(925)100-12-04, sapresyan@mail.ru, https://orcid.org/0000-0002-7310-974X
Corresponding author: Evgeny F. Kira, profkira33@gmail.com
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