As an adult starting a family of your own, you're probably not all that preoccupied with childhood illnesses such as chickenpox. After all, those bugs are just for kids, right? Wrong. In fact, if you come down with them while you're pregnant, they can harm your baby. The good news? Most pregnant women are immune to such illnesses. Still, it's hard to know if you're immune. For this reason, it's important to talk to your doctor about taking steps to protect your baby. And if you're not pregnant yet, see your doctor for a checkup and find out which illnesses you should be concerned about.
You're probably familiar with the pimply rash that ushers in a case of chickenpox (varicella). This virus is usually accompanied by a fever and is spread by respiratory droplets in the air. You can also get it by coming into direct contact with the rash. Luckily, 85 to 95 percent of pregnant women are immune because they've already had chickenpox. If you're sure you've had it, don't worry. If not, take note; about one in 2,000 women will develop chickenpox during pregnancy.
Serious complications from the virus are uncommon in children, but about 15 percent of infected adults develop a form of pneumonia, which is particularly dangerous for pregnant women. What's more, their babies face a small risk (about 1 percent) of congenital varicella syndrome, a group of birth defects that can include severe muscle and bone abnormalities, paralyzed limbs, blindness, and even mental retardation.
Another risk of chickenpox during pregnancy is that the newborn may get it, too. If the mother develops the rash between five days before to two days after delivery, the newborn has a 25 to 50 percent chance of contracting the disease. It can be severe in newborns: Up to 30 percent die if they're not treated right after birth with an antiviral drug called VZIG (varicella-zoster immune globulin).
Ideally, women who haven't had chickenpox or who aren't sure of their immunity status should be tested before pregnancy. Women who are not immune may receive the chickenpox vaccine and should wait at least one month after receiving it before trying to conceive.
If you're already pregnant and unsure of your chickenpox status, you'll receive an immunity test. Women who are not immune should avoid anyone with chickenpox and anyone who has been in contact with someone who has chickenpox. If you're exposed, your doctor will probably recommend treatment with VZIG. When given within 72 hours of exposure, VZIG helps prevent chickenpox or lessens its severity -- doctors are unsure as to whether or not it helps protect the fetus from infection. If all else fails and you wind up with chickenpox, you'll be treated with an antiviral drug called acyclovir to ease the symptoms.
Like many childhood illnesses, fifth disease (erythema infectiosum), is caused by an airborne virus. Fortunately, this virus is usually mild. Most infected children get a reddish facial rash and, less commonly, a mild fever, sore throat, and joint pain. Infected adults are less likely to develop the rash but are more likely to have joint pain and flulike symptoms. Twenty percent of infected people are symptomless.
About 60 percent of adults have had the infection in childhood and are immune. Like most people, you probably don't know whether you've had fifth disease, so it's best to assume you're at risk. If a pregnant woman gets it, there is a small risk that it could harm her baby. The virus can disrupt the baby's ability to produce red blood cells, and the baby could contract a form of anemia, which can lead to heart failure, miscarriage, or stillbirth.
Child-care providers, health-care workers, teachers, and women with young children are most likely to be exposed. If there's an outbreak of fifth disease at your workplace, talk to your doctor about whether you should stay home until it subsides. To reduce the risk of infection, wash your hands thoroughly after touching objects and surfaces used by infected children. If your child is going through a lot of tissues or wipes, discard them promptly.
Call your doctor right away if you've been exposed to fifth disease. He may recommend a blood test to determine whether you currently have the illness. If you're infected, he'll monitor you carefully for signs of fetal infection. Severe fetal complications can often be detected through repeated ultrasound examinations. Most of these problems develop 10 weeks after infection. If ultrasound doesn't show any problems at this time, no further testing is needed.
Doctors are currently trying to determine the most effective way to treat unborn babies with fifth disease complications. Researchers can diagnose the infection in the baby using a sample of amniotic fluid or fetal blood, obtained through the umbilical cord using a procedure called percutaneous umbilical blood sampling, or PUBS. PUBS can also be used to determine the severity of fetal anemia, and to deliver a blood transfusion to the fetus if it's needed. Fortunately, some fetuses with severe complications recover without treatment and appear normal at birth.
Also caused by a respiratory virus, measles (rubeola) is characterized by rash, fever, cough, and runny nose, and frequently results in complications such as pneumonia. Most pregnant women today are immune to measles, due to widespread vaccination that began in the 1960s. However, outbreaks occasionally occur, and inadequately vaccinated adults can be at risk of getting sick.
It's rare to get measles during pregnancy. However, when a pregnant woman does get it, she is at increased risk of miscarriage, preterm delivery, and stillbirth. As with chickenpox, the newborn is also at risk of contracting the illness if the mother gets it near the time of delivery. The newborn can be treated with a therapy called immune globulin. A susceptible pregnant woman who is exposed to measles should also be treated with immune globulin to help prevent the illness.
Chances are you're immune to these ailments. But make sure to check with your doctor if you're exposed to these or other illnesses, to protect your health and your baby's.
Richard H. Schwarz, MD, obstetrical consultant to the March of Dimes, is past president of the American College of Obstetricians and Gynecologists.
The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.