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Pregnancy Bliss | Reproductive Health Hub

Continued from previous page

Rubella (German measles) and pregnancy

If I am exposed to Rubella (German measles) in pregnancy, what should I do?

Most mothers born after the mid-1960s will have been immunized and over 90 per cent of these will have acquired long-term immunity. A fair proportion of the rest will have had the infection and acquired immunity that way. If you are unsure whether you are immune or not, you should see your doctor promptly to have a blood test to establish your immune status.

If I am immune to Rubella, can my baby be affected by my exposure to the infection during pregnancy?

No. You are immune, so you cannot acquire the infection and therefore cannot pass it on to the fetus.

If I am found not to be immune, is there anything that can be done to help the fetus?

If you acquire the infection during pregnancy, there is nothing that can be done to influence what happens to the baby. Since most Rubella infections are unrevealed, if you have been exposed, blood tests will be required to confirm whether the infection has indeed been passed on to you.

What are the effects of a rubella infection on the fetus?

Rubella causes what is called "Congenital Rubella Syndrome". The earlier in pregnancy the infection is acquired, the more severe the features of the syndrome. They may include some or all of the following:

The syndrome could be so severe as to make the quality of life of the child questionable. Most (over 70 per cent) of babies will be affected, to varying degrees, if the mother acquires the infection in the first twelve weeks of pregnancy.

As there appears to be a window for a few babies to escape infection, is there any test that can identify babies that have been affected and those who have escaped?

Yes, but unfortunately this can only be done and is only reliable after twenty weeks of gestation. A cord blood sample is taken and analysed to establish whether the infection was passed to the fetus. This procedure does carry a small but significant risk of killing the fetus or provoking a miscarriage.

What are the options for the mother who has been exposed to Rubella in the early part of the pregnancy?

It is important to confirm (by doing the appropriate test) whether what she has been exposed to is indeed Rubella. This is because a few other infections do have symptoms similar to Rubella. If it is established that she was exposed to Rubella and that she has acquired the infection, the mother is faced with the difficult decision of terminating the pregnancy or taking chances with it. Unfortunately, most babies exposed at this stage of pregnancy will be affected.

Suppose the exposure is late in pregnancy?

The proportion of babies affected if exposure is in late pregnancy is reduced and so is the severity. Nonetheless, infection should be confirmed, using a blood test. The obstetrician should then discuss with the mother whether she wants to have an invasive test to check whether the baby has been affected as well. Many probably wait to have this done after delivery. If infection of the baby is confirmed, monitoring of the growth and general health of the child are all that is required.

Some features of congenital rubella syndrome appear late. These may include:

 thyroid dysfunction

 diabetes

 abnormally early puberty (precocious puberty).

What is the advice if rubella vaccination is inadvertently given during pregnancy?

Nothing really needs to be done. There has been no recorded adverse effect as a result of vaccination in pregnancy. How­ever, no deliberate vaccination should be carried out in pregnancy.

Is there anything else that can be done to reduce the effect of rubella infection during pregnancy?

Nothing really. Even though there is an immunoglobulin preparation to confer passive immunity to exposed individuals, this is not recommended for administration in pregnancy. This is because it is known not to prevent fetal infection and there is no evidence that it could reduce the severity of the effects of the infection to the fetus.

Just remember, most adult women will be immune to Rubella either through childhood vaccination or previous infection.

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