Spotting During Pregnancy: What Is and Isn’t Normal?

Bleeding during pregnancy is one of those things that can cause your stress level to skyrocket. It’s scary to see blood anytime outside of your period, especially when you’re pregnant.t’s easy to start imagining the worst.

But don’t panic just yet. It’s really common—according to the American College of Obstetrics and Gynecologists (ACOG), spotting happens in 15 to 25% of pregnancies, especially in the first trimester. There are a number of reasons it occurs, many of them totally benign. Most people who experience pregnancy spotting will go on to have completely healthy pregnancies. If you’re worried, one of the key things to know is the difference between spotting and bleeding.

What does pregnancy spotting look like?

The difference between spotting and bleeding is the amount of blood you see.

“Spotting is usually very light,” Washington, DC-based ob-gyn Dr. Cordelia Nwankwo says. “It can be pink, red, or even brown, and usually doesn’t require a pad.” But bleeding is different. “[Bleeding] is persistent or increases in amount (ex: a more consistent flow, or if you’re filling up a liner) and should be evaluated,” Nwankwo says.

It’s important to recognize the distinction, especially when you’re pregnant. “Most causes [of spotting] tend to be benign in nature,” Nwankwo says. Bleeding, she says, could indicate more serious issues and should be evaluated by your healthcare provider.

What causes spotting during pregnancy?

The main cause of pregnancy spotting is irritation. “Spotting is not uncommon especially after things like intercourse or vigorous activity,” says Nwankwo. “Even straining with bowel movements can sometimes lead to spotting.” Your cervix tends to be more sensitive during pregnancy, making it more prone to irritation that can cause spotting. Other types of irritations that can lead to spotting include a transvaginal ultrasound or heavy lifting.

You may have also heard about implantation bleeding. “Implantation bleeding is thought to be light bleeding that occurs about 10 days after ovulation (the week before your period),” Dr. Nwankwo says. But keep in mind that the jury’s out on this type of bleeding. “There are no studies that actually confirm early [spotting] as being caused by implantation,” Nwankwo says.

What causes bleeding during pregnancy?

There are a few potential causes of pregnancy bleeding, according to the ACOG:

• Infection. A cervical infection—also called cervicitis—is an inflammation of the cervix. These bacterial infections can often cause spotting during pregnancy. If this is the cause of your spotting, your doctor can prescribe treatment.
• Cervical polyp. A growth on the cervix, a cervical polyp can often cause pregnancy bleeding. That’s because when you’re pregnant, there’s an increased number of blood vessels in the tissue around the cervix, and a greater likelihood of a bleed developing.
• Subchorionic hematoma. A subchorionic hematoma is the accumulation of blood between the uterus and the placenta within the folds of the chorion (that’s the outer fetal membrane, next to the placenta). This condition can cause anything from light spotting during pregnancy to heavy bleeding. In most cases, it doesn’t affect the health of the pregnancy and will resolve on its own, but you should talk to your doctor if your bleeding continues.
• Miscarriage and ectopic pregnancy. Although the odds are in your favor that it’s not a serious issue (light episodes of pregnancy spotting, for instance, especially when they last for 1-2 days, are not associated with a higher risk of miscarriage), bleeding during pregnancy can be a sign of something more serious. Unfortunately with a miscarriage, there’s no way to know what’s going on without visiting your doctor, as the amount of spotting doesn’t always correlate with whether or not you’re miscarrying. In the case of an ectopic pregnancy (when the fertilized egg attaches to a place other than inside the uterus, most often in the fallopian tubes), if you’re experiencing spotting along with other symptoms—one-sided abdominal pain, dizziness or weakness—you need to reach out to your doctor as soon as possible for monitoring and treatment.

Some of these causes may be concerning, but the good news is the majority of them don’t lead to major complications, are completely treatable and aren’t cause for alarm.

Is spotting normal during pregnancy?

Spotting during pregnancy may be scary, but it’s not uncommon at all.

“At least 25 percent of women have some light bleeding, especially in the first trimester,” says Dr. Clara Ward, maternal-fetal medicine physician with McGovern Medical School at UTHealth/UT Physicians in Houston. “While the experience may still be worrisome, fortunately, it is generally not serious and not likely to have a negative effect on the pregnancy.”

According to Ward, the most common time for pregnancy spotting to occur is during the first trimester. Later in the pregnancy, spotting can be a sign of a more serious complication, like placental abnormalities or preterm labor. But the good news is that if this is the first time you’re seeing some blood during your pregnancy, “an isolated episode of spotting in early pregnancy is usually not a cause for concern,” says Nwankwo.

When should you contact your doctor?

It’s always a good idea to reach out to your doctor if you’re experiencing spotting—or anything else that seems out of the ordinary during your pregnancy.

Don’t be worried about bothering them or asking too many questions. According to Ward, it’s vital to always give your doctor a full description of your symptoms; it’s what helps your healthcare provider determine if you need further evaluation.

“Additional symptoms, such as cramping or fever, almost always warrant a call, even if the spotting is mild,” Ward says. “Pain or heavy bleeding that requires a pad requires immediate attention, as does any bleeding that occurs in the second or third trimesters, as these may be signs of a bigger problem.”

With all that, try to remember that spotting during pregnancy is common, and hopefully knowing what to look out for can help you feel better.

Sources:

• American College of Obstetrics and Gynecologists: Bleeding During Pregnancy: https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy
• Dr. Cordelia Nwankwo: OBGYN: https://www.cwcare.net/profile-provider/346
• Oxford Academic (Oxford University Press): Vaginal bleeding in very early pregnancy: https://academic.oup.com/humrep/article/18/9/1944/708284
• National Library of Medicine: Association Between First-Trimester Vaginal Bleeding and Miscarriage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828396/
• Dr. Clara Ward: maternal-fetal medicine: https://med.uth.edu/obgyn/faculty/clara-e-ward-md/