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DAVID HOLLANDER, M.D.
Attending Obstetrician/Gynecologist
Like all adults, pregnant women are at risk for getting
many viral infections. However, infections are of particular
concern during pregnancy since some are associated with significant
maternal and fetal consequences. As with most diseases, prevention
is of utmost importance. Fortunately, women can take steps
to decrease the chance of contracting a potentially harmful
illness during pregnancy. The identification and, when possible,
treatment of infections before pregnancy reduces complications
in the newborn. For some, when no prior treatment is available,
avoidance and good hygiene are the best solution. We will
discuss many of the common and not so common illnesses and
offer some guidelines for counseling and management.
Measles, mumps and rubella (German measles) are the most
recognizable illnesses. Rubella is associated with an increased
risk of miscarriage and can also cause congenital rubella
syndrome, which can lead to visual problems, heart defects
and abnormalities of the central nervous system, including
mental retardation. Measles can increase preterm birth and
possibly miscarriage, while mumps in the first trimester appears
to be associated with an increased risk of fetal death. The
use of the MMR vaccine protects against these three infections.
It is a live vaccine and pregnancy should be avoided for 30-60
days after receiving the immunization. Postpartum women as
well as breastfeeding women may receive the vaccine safely.
Varicella or chicken pox may affect women who are in the
first twenty weeks of pregnancy. The fetus is at risk for
a fetal syndrome marked by a small head and limbs, mental
retardation, scarring of the skin and eye defects. If the
mother is infected at the time of delivery, it can cause major
discomfort and potentially lethal infection to the mother.
The disease can be passed on to the newborn at this time.
Varicella vaccine is a live virus so it, too, must be given
prior to pregnancy in those who are not immune.
If one does get the infection in pregnancy, there are medications
to lessen the symptoms in the mother, and, more importantly,
if exposure to varicella is known in a person who has never
had the disease, there is a treatment to lessen the severity
of the infection.
In addition to the routine immunizations, pregnant women
should consider the influenza vaccine. Influenza or the flu
may cause serious medical complications, particularly in high-risk
patients. Vaccination against the flu is recommended for pregnant
women whose pregnancy overlaps the flu season, regardless
of how far along they are in the pregnancy. Those who are
at high risk because of diabetes, blood disorders, impaired
immune systems or chronic lung and heart problems should be
vaccinated with a flu shot given in the second or third trimester.
Women can safely breastfeed after receiving the vaccine.
Several additional infectious diseases, for which there
are no vaccines, can cause problems in pregnancy. They are
best avoided by practicing good hygiene and attempting to
avoid direct contact with an infected individual.
Parovirus B19, also known as Fifth
disease, is common in
children and causes fever, mild fatigue, malaise and joint
pain in adults. A distinctive red rash on the face in children
is also a symptom. Although its occurrence in pregnancy is
infrequent, it can cause serious fetal problems. In the first
trimester it can cause severe fetal anemia leading to death.
Ideally, pregnant women who have never had the infection should
avoid contact with the virus. However, this is difficult,
so careful handwashing and strictly avoiding the sharing of
food and drink can help in prevention. Testing for the B19
virus can be reassuring. If the pregnant woman has the virus,
she should be monitored with a series of ultrasounds for 8-10
weeks to assure fetal well being.
Cytomegalovirus (CMU) is a common virus that is transmitted
by sexual contact or other intimate contact with the saliva,
urine or bodily fluids. It can be passed from mother to fetus
in pregnancy and to infants via pregnant women, such as mild
low-grade fever and mononucleosis-type symptoms. Cytomegalovirus
is the most common viral infection passed to the fetus and
is the leading cause of congenital hearing loss. Vision and
neurologic problems may develop if the fetus contracts the
virus. Infants who do not contract the virus in utero may
get a milder form at delivery through breastmilk. Premature
infants, however, may not be as lucky and can be affected
more adversely. Medications and vaccines are being studied
but are not available at the current time.
Although not a virus, Toxoplasmosis is an illness caused
by a parasite. It can be linked to congenital disease if infection
first occurs during pregnancy. If a woman develops the infection
in pregnancy, the baby has a 33 percent chance of having the
infection. This infection is carried in the feces of cats,
but the main source of transmission is consuming undercooked
meat that contains the disease. Pregnant women should, therefore,
avoid rare or undercooked meat. While it is not clear that
changing the cat's litter box is a major risk for getting
the disease, it is probably reasonable to have someone else
change the litter box and to wash hands when finished.
Finally, in addition to immunization with vaccines and attention
to hygiene, women can take measures to avoid exposure to infectious
agents known to cause problems during pregnancy. Avoiding
travel to high-risk locations is effective. If you are planning
to travel during pregnancy, be sure to consult with your physician
about the safety of your planned trip. It is also important
to make sure that children and other family members are up-to-date
with their immunizations to during pregnancy.
Remember that your physician is the best resource for finding
important information related to your particular case. Not
all pregnancies are alike and it is important that your situation
is evaluated by someone who knows you and your medical history.
For a referral to a Saint Barnabas Medical Center obstetrician/
gynecologist, please call 1-888-SBMC-DOC.
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Chicken Pox