Infections during pregnancy

Pregnancy doesn't make you immune from everyday infections and illnesses. It may, however, change the way an infection is managed by your health care provider. This section explores how pregnancy might be affected by various infections.

Chickenpox

Chickenpox (varicella) is caused by the varicella-zoster virus. It's a common and highly contagious childhood illness characterized by red, itchy spots on the skin. About 4 million Americans, mostly children, contract the illness each year. Adults also can have chickenpox.

A vaccine to prevent chickenpox became available in 1995. Now, children are routinely vaccinated against the illness, and the number of current and future cases is expected to decline. Those who had chickenpox or were vaccinated against it are typically immune to the virus. If you're not sure whether you're immune, your health care provider can perform a blood test to find out.

The vaccine isn't approved for women who are pregnant. But if you're susceptible to the illness and still haven't conceived, your health care provider may recommend getting vaccinated and putting off pregnancy for a month or more. In childhood, chickenpox is generally a mild disease. However, in adults — and especially in pregnant women — it can be serious. If not treated, it can lead to complications such as pneumonia.

Managing chickenpox during pregnancy

Chickenpox early in pregnancy very rarely results in birth defects. The greatest threat to the baby is when a mother develops chickenpox the week before birth. It can cause a serious, life-threatening infection in a newborn. Usually, an injection of a drug called varicella-zoster immune globulin (VZIG) can lessen the severity of the infection if a baby is treated quickly after birth.

Pregnant women exposed to chickenpox also need protection with this drug to diminish the severity of the disease. Treating an expectant mother with VZIG within 72 hours of exposure appears to reduce the risk of pneumonia and other serious complications.

Cytomegalovirus

Cytomegalovirus (CMV) is a common viral infection. In healthy adults, almost all CMV infections go unrecognized. However, infected adults sometimes experience signs and symptoms such as a fever, a sore throat, aching muscles and fatigue.

Up to 85 percent of all adults in the United States are infected with CMV by age 40. An infection can recur, but recurrences are likely to go unnoticed. After you've been infected by CMV, you can shed the virus for years in saliva, urine or breast milk.

Managing cytomegalovirus during pregnancy

CMV can be passed from one person to another through infected body fluids. A pregnant woman with CMV can infect her baby with the virus before birth, during delivery or while breast-feeding. In the United States, CMV is the viral infection most frequently passed from mother to child before birth.

When a woman has a recurrent infection of CMV during pregnancy, less than 1 percent of fetuses are infected. Those who do contract CMV rarely develop any serious problems related to the infection.

Women who contract CMV for the first time during pregnancy have a greater risk of passing a severe congenital infection on to their babies. Often, CMV infections go unnoticed in infants because they have no signs of it at birth. However, CMV may have serious effects on these children. A small number may have neurologic problems such as learning disabilities. Up to 10 percent will have some degree of hearing loss.

About 1 percent of infants show signs and symptoms of CMV at birth. These include severe liver problems, seizures, blindness, deafness and pneumonia. Up to 20 percent of these babies die. The majority of those who live have serious neurologic defects.

An amniocentesis can test for infection in the fetus if CMV is diagnosed in a pregnant woman. Your health care provider may recommend a series of ultrasounds to see if the fetus develops structural problems related to the infection. No treatment currently exists for congenital CMV, but new vaccines are being studied.

Fifth disease

Fifth disease (erythema infectiosum) is a contagious infection common among school-age children. This condition is caused by the human par-vovirus B19. Sometimes, it's also called slapped-cheek disease because the most noticeable part of the infection in children is the bright red rash on the cheeks. A lacy red rash may also be seen on the legs, trunk and neck. Many children with fifth disease feel well. Other children may have a mild fever, upset stomach and other flu-like symptoms.

In adults, the most noticeable symptom is joint soreness, which may last from days to weeks. Adults are much less likely to develop the telltale rash than are children. Infection can also occur without signs or symptoms in either children or adults. For this reason, many adults may not know if they had the infection in childhood. Once you've had the infection, you're generally immune from getting it again.

Fifth disease is contagious for up to a week before the onset of the facial rash, so it's difficult to stop its spread. The time between exposure and development of the disease ranges from four to 14 days. Currently, no vaccine exists to prevent fifth disease. Antiviral therapy hasn't yet been shown to benefit women with the infection.

Managing fifth disease during pregnancy

Between one-fourth and one-half of pregnant women remain susceptible to the B19 virus during pregnancy, so it's not uncommon for expectant women to contract the disease. The great majority of these women will have healthy babies.

In rare cases, however, fifth disease in the mother can cause severe, even fatal, anemia in the fetus. The anemia can cause congestive heart failure in the fetus, manifested by a severe form of swelling (edema) called fetal hydrops. If a fetus develops this complication, it may be possible to give the fetus a blood transfusion through the umbilical cord.

If a pregnant woman has been exposed to fifth disease or is suspected of having it, blood tests can help determine immunity or confirm infection. If the blood tests show immunity, there's no cause for concern. If the tests show evidence of fifth disease, additional ultrasounds might be done for up to 12 weeks to watch for possible signs of anemia and congestive heart failure in the fetus.

Group B streptococcus

Up to 35 percent of adults in the United States carry a bacterium known as Group B streptococcus (GBS). For women with GBS, it's normal for the organism to reside in their colons and rectums. Typically, GBS lives harmlessly in the body. However, pregnant women who harbor GBS may pass it to their babies during labor and delivery. Babies who acquire this infection may become seriously ill.

Managing group B streptococcus during pregnancy

Only a small number of babies born to women carrying group B strep become ill. However, it's now clear that using antibiotics during labor to treat women who carry the bacterium will prevent most of these infections. Women who carry GBS don't show symptoms, so all women should be screened for it.

If GBS infects a newborn, the resulting illness can take one of two forms: early-onset infection or late-onset infection. In early-onset infection, a baby typically becomes sick within hours after birth. Problems can include infection of the fluid in and around the brain (meningitis), inflammation and infection of the lungs (pneumonia) and a life-threatening condition called sepsis, which can cause fever, difficulty breathing and shock. Up to 20 percent of babies with early-onset GBS infection have long-term problems or die, even with immediate treatment. Using antiobiotics during labor to treat pregnant women who carry GBS can prevent the majority of these infections.

Late-onset infection occurs within a week to a few months after birth. It usually results in meningitis. Although meningitis is serious, the death rate isn't as high as in the early-onset form.

Children who survive either type of infection can have long-term neurologic problems.

Listeriosis

Listeriosis is an illness caused by a type of bacteria called Listeria monocytogenes. Most infections result from eating contaminated foods. Commonly involved are processed foods such as deli meats and hot dogs, unpasteurized milk and milk products such as soft cheeses.

Most healthy people exposed to listeria don't become ill. But at times the infection can cause flu-like problems such as fever, fatigue, nausea, vomiting and diarrhea. These problems are somewhat more likely during pregnancy.

Managing listeriosis during pregnancy

If you contract listeriosis during pregnancy, the infection can be passed from you to your fetus through the placenta. It can lead to premature delivery, miscarriage, stillbirth or the death of the baby shortly after birth.

It's important to make every effort to prevent exposure to listeria during pregnancy. Listeria contamination events are usually recognized, and warnings are often reported in the news. If you're pregnant, heed these warnings. In addition, always avoid consuming unpasteurized dairy products.

German measles

German measles (rubella) is a viral infection. It causes fever, swollen lymph nodes, aching joints and a rash. Rubella is sometimes confused with measles (rubeola), but each of these illnesses is caused by a different virus.

Rubella is extremely rare in the United States. Most young children are vaccinated against it with the measles-mumps-rubella (MMR) vaccine. As a result, most women in their childbearing years are immune to rubella. Long-term immunity develops in at least 95 percent of the people who receive the vaccine.

However, small outbreaks of rubella continue to occur in the United States. That means it's possible for you to become infected during pregnancy if you aren't immune.

Managing German measles during pregnancy

German measles is a mild infection. However, if you contract it while you're pregnant, it can be dangerous. The infection can cause miscarriages, stillbirths or birth defects. Birth defects may include growth retardation, mental retardation, cataracts or other eye problems, deafness, congenital heart defects and defects in other organs. The highest risk to the fetus is during the first trimester, but exposure to rubella during the second trimester also is dangerous.

Early in pregnancy, women are routinely tested for rubella immunity. If you're pregnant and found not to be immune, avoid contact with anyone who may have been exposed to German measles. The MMR vaccines isn't recommended during pregnancy. However, you can be vaccinated after childbirth so that you will be immune to rubella in future pregnancies. If you're not pregnant and choose to receive the vaccine, you'll be advised to wait at least three months before becoming pregnant.

Toxoplasmosis

Toxoplasmosis is a parasitic infection that's carried by rodent-eating cats. The risk of infection from cleaning an indoor cat's litter box is low. Outside soil or sandboxes may contain the parasite from outdoor cats, especially in warm climates.

The most likely route to acquiring the infection is through contaminated foods. Good food preparation practices are the most effective route to prevent this infection.

In many cases, toxoplasmosis causes no signs and symptoms. It often goes undiagnosed. When signs and symptoms occur, they're often similar to what you would experience with the flu, such as swollen lymph glands, fatigue, muscle aches and fever.

An active infection usually occurs just once. It generally results in immunity to the disease. Pregnant women who have immunity won't pass the infection to their babies. However, women who contract toxoplasmosis for the first time during pregnancy have about a 40 percent chance of infecting their babies.

If you're unsure about whether you're immune, use these tips to help avoid infection:

• Eat only thoroughly cooked meat.

• Wash your hands well after food preparation.

• Wear gloves when gardening or handling soil.

• If you have a cat, have someone else clean its litter box.

Managing toxoplasmosis during pregnancy

Infection with toxoplasmosis during pregnancy can lead to problems. It may result in miscarriage, growth problems for the fetus or preterm (before the 37th week) labor. The majority of fetuses who acquire toxoplasmosis develop normally. However, the disease may cause problems in babies, including blindness or impaired eyesight, an enlarged liver or spleen, jaundice, seizures and mental retardation.

Women aren't routinely screened for toxoplasmosis during pregnancy in most areas. If an infection is suspected, your health care provider can check with a blood test. If the test indicates a current infection, prenatal tests, such as amniocentesis and ultrasound, may help determine if there's a fetal infection. To diagnose toxoplasmosis in a baby after birth, a health care provider may study the placenta, test the spinal fluid and have your baby undergo a computerized tomography (CT) scan of the head.

Treating toxoplasmosis during pregnancy can be difficult. It isn't clear whether the medications used to treat it are effective for the fetus, and the mother rarely requires treatment. Treatment will depend on your circumstances.

COMPLICATIONS

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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