Pregnancy is an extraordinary and transformative time in a woman’s life — filled with anticipation, joy, and a powerful instinct to protect the little miracle growing within. One topic that deserves attention is the importance of safeguarding against common illnesses, especially ones that can be inadvertently picked up from children or other babies. It’s not unusual for expectant mothers with young kids or toddlers to sometimes catch common bugs that their little ones bring back home from childcare or school.
This article will guide you through understanding the typical childhood illnesses and remind you of the importance of protecting yourself from infectious diseases during pregnancy. Armed with knowledge about potential risks, preventive steps, and ways to cultivate a healthy environment, you’re on your way to ensuring the best health outcomes for both you and your upcoming bundle of joy!
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Common Infections Affecting Mother & Baby
HAND, FOOT, AND MOUTH DISEASE
Hand, Foot, and Mouth Disease (HFMD) is a common viral infection caused by the Coxsackie virus. It mainly affects infants and young children under 5 years but occasionally affects adults. There are different strains so it is possible to get it more than once. It is usually not serious but very contagious and is a common source of headache to parents when outbreaks happen at the pre-school.
How It Spreads
This viral infection is highly contagious and spreads through close contact with an infected person’s saliva, respiratory droplets, faeces, or fluid from blisters. It is most contagious during the first week of illness but can spread for 1-3 weeks. It is easy to get from hugging a child or changing a diaper.
Recognising The Symptoms
The symptoms of HFMD can vary, but typically include:
- Sore throat
- Mouth sores/ulcers
- Rash: The rash appears on the palms of the hands, soles of the feet, on the face and occasionally the buttocks, legs and arms. It consists of small, red spots or blisters that may be painful or occasionally itchy.
- Loss of appetite and dehydration
Many adults with the disease can be asymptomatic though they can transmit the virus. In adults, symptoms that show up eg rash tend to linger longer sometimes for weeks compared to children where it usually resolves in a week.
Implications on pregnancy
The chance that a fetus is affected is very small. There is no clear evidence that infection increases the risk of miscarriage, still birth or birth defects. However, if a mother is infected right before birth, the newborn is at risk of getting infected and while most will be mild, they rarely may develop complications like meningitis (inflammation of brain covering) or encephalitis ( inflammation of brain). HFMD is typically a mild self limiting condition that can be treated at home. With the correct precautions and prompt healthcare monitoring, it can be successfully navigated during pregnancy.
Chickenpox is a common illness we might remember from childhood, caused by the Varicella-Zoster Virus (VZV). While it’s possible to encounter chickenpox during pregnancy, the good news is that most adults (estimated 90%) have already had chickenpox and, therefore, have immunity. The chances of experiencing chickenpox for the first time while pregnant are quite slim.
How It Spreads
Chickenpox spreads through close contact, like touching the rash of an infected person or inhaling tiny droplets when they cough or sneeze. If you’ve never had chickenpox or the varicella vaccine, there’s a chance you could get the infection if you come into contact with someone who has it. Remember, a person with chickenpox can spread the virus a couple of days before their symptoms appear and until all their rash spots have crusted over.
Recognising The Signs
Chickenpox typically shows up as:
- A red, itchy rash starting on the face, chest, and back, spreading across the body later.
- The rash gradually turns into small, fluid-filled blisters that crust over.
- Accompanying fever, tiredness, headache, and body aches.
Implications for Pregnancy
If infected with chickenpox during the first 20 weeks of pregnancy, there is a risk of the virus crossing the placenta and affecting the developing fetus. This can result in congenital varicella syndrome, a rare condition characterised by congenital disabilities, including skin scarring, eye abnormalities, limb deformities, neurological problems, and developmental delays. This condition happens in only about 1% of babies with affected mothers and most babies will not be affected.
If you contract chickenpox around the time of birth, there’s a chance your newborn could get a more severe form of chickenpox called neonatal varicella. This can be promptly treated with Varicella Zoster immunoglobulin (antibodies) and antiviral drugs to help your baby recover.
For the majority of expectant moms, chickenpox only causes mild symptoms. However, a tiny fraction might experience more serious conditions like pneumonia or inflammation of the brain or liver. Please rest assured, these complications are very rare. If a pregnant patient gets infected after 20 weeks gestation, she can be given an anti-viral called acyclovir within 24 hours of the rash developing to reduce fever and symptoms.
Cytomegalovirus (CMV) is a common viral infection with an estimated half of adults infected by age 40. Once infected, the virus stays for life and can re-activate during periods of low immunity. It is also possible to be reinfected with different strains.
How It Spreads
CMV is typically transmitted through close contact with an infected person’s body fluids, including urine, saliva, blood, and breast milk. Young children are a common source of CMV. One third of pre school children would have gotten CMV by 5 yrs old but usually do not have symptoms. The virus can stay in the body fluids for months after the infection. Expectant moms may come across CMV when in contact with young children, especially if they have frequent exposure to their bodily fluids like changing diapers.
Recognising The Signs
Many individuals with CMV may not even realise they are infected, as they often experience no symptoms or only mild flu-like symptoms, including:
- Muscle aches
- Sore throat
- Swollen lymph nodes
Congenital CMV Infection. CMV can cross the placenta and infect the developing fetus, leading to congenital CMV infection. While most babies never show signs or experience any long-term effects, others may develop complications at birth or later that can significantly impact their health and development. There is a very variable presentation to congenital CMV.
If a pregnant woman contracts CMV for the first time during pregnancy, there is a 1 in 3 chance of transmitting CMV to their fetus versus only 1% chance in patients with a recurrent infection. Possible complications of congenital CMV include rash, jaundice, low birth weight, enlarged liver and spleen, hearing loss, vision impairment, intellectual disabilities, learning difficulties, developmental delays, seizures and microcephaly (baby’s head is smaller than expected due to underdevelopment of the brain). The birth prevalence of congenital CMV infection is uncommon at approximately 1 in 200 births with birth defects or long term health issues in 1 in 5 of those infected babies.
CMV is not routinely screened in pregnancy but the test may be done if there are ultrasound abnormalities or if the mother presents with the above flu-like symptoms. Cytomegalovirus (CMV) infection during pregnancy requires careful management and monitoring to minimise potential risks to both the mother and the developing fetus. Referral to a high risk pregnancy specialist and co management with an infectious disease specialist is likely required. Babies who show signs at birth may be treated with anti-virals.
Fifth disease, also known as erythema infectiosum or slapped cheek syndrome, is an infection typically caused by parvovirus B19. This infection is usually mild in children and adults. Half of pregnant patients are typically immune and hence protected.
How It Spreads
Fifth disease is primarily transmitted through respiratory droplets when someone infected coughs or sneezes. It can also be transmitted through direct contact with an infected person’s respiratory secretions or blood. Therefore, expectant mothers can encounter this disease when interacting closely with infected individuals, especially children.
Recognising The Symptoms
Many cases of fifth disease in children and adults cause no symptoms or only mild symptoms, including:
- Slapped cheek rash: a bright red rash on the cheeks that gives the appearance of being “slapped,” which can spread to other parts of the body, including the trunk, arms, and legs.
- A red, lacy rash may appear on the body, often accompanied by itching.
- Cold-like symptoms
Implications in pregnancy
Rarely , Parvovirus B19 can cause a miscarriage or can affect the production of fetal red blood cells, leading to anaemia. In very rare cases, a severe form of fetal anaemia called hydrops fetalis can occur potentially leading to heart failure and other complications. This happens in less than 5% of infections and mainly if the infection occurs early in pregnancy.
Fifth disease typically resolves on its own without specific treatment. Symptomatic management, such as rest and hydration, can provide relief. For individuals at higher risk of complications, like pregnant women, it is essential to consult with healthcare professionals to ensure appropriate monitoring and management.
RUBELLA (GERMAN MEASLES)
Rubella is a viral infection caused by the rubella virus. While this viral disease could potentially cause severe consequences for pregnant women and their fetuses, it’s comforting to know that most people are vaccinated against Rubella during childhood and are protected. However, in some cases, these protective effects may gradually lessen over time as the antibodies wane.
How It Spreads
Rubella is primarily transmitted when an infected person sneezes or coughs, releasing tiny droplets into the air and a susceptible person inhales virus-containing particles in the air. You could also catch it by coming into close contact with an infected person’s nasal or throat secretions eg sharing food.
Recognising The Signs
The signs of rubella are usually quite mild, and some may not have symptoms at all. These include:
- A pink or light red rash that often starts on the face before spreading to the rest of the body.
- A low-grade fever.
- Tender and swollen lymph nodes, especially behind the ears and at the back of the neck.
- Symptoms that resemble a common cold.
Implications on pregnancy
Congenital Rubella Syndrome (CRS) If a pregnant woman is infected with rubella, especially during the first trimester, the virus can cross the placenta and seriously affect the developing fetus. The risk of transmission to the fetus is more likely the earlier the mother becomes infected during pregnancy (85% chance of getting infected in the first trimester versus 25% if later than the second trimester). CRS is characterised by a range of birth defects, including hearing loss, vision problems, heart abnormalities, intellectual disabilities, and developmental delays. It is also associated with growth restriction leading to low birth weight and increased risk of miscarriage.
Unfortunately there is no cure for CRS and no specific antiviral treatment exists. The most effective safeguard against potential rubella-associated complications is preventive vaccination before pregnancy.
Prevention and treatment play a crucial role in minimising the risks of childhood infections during pregnancy. Here are some strategies that pregnant women can adopt to avoid exposure to infections, along with the importance of vaccination and medical interventions.
- Practise good hygiene. Regularly wash your hands with soap and water, especially after being in public places or in contact with potentially infected individuals. Parents and child care providers can lower their risk of getting CMV by reducing contact with saliva and urine from young children eg not sharing food, utensils or cups with a child and washing hands properly after changing diapers. Consider wearing gloves when changing diapers of infected children. Wash and sanitize toys that may have an infected child’s saliva on them. Wash and disinfect high traffic surface areas that an infected child often touches or puts in their mouth eg door knobs or toys.
- Avoid close contact. Minimise contact with individuals who have known infections, especially respiratory or contagious diseases. This includes avoiding crowded places or gatherings with higher exposure risk and using a face mask to protect yourself when anyone at home is unwell.
- Stay informed. Stay updated on common childhood infections and their symptoms to recognise potential sources of exposure. Watch out for signs of infections in your child.
- Know about pre-pregnancy vaccinations. Ensure that you are up to date with your vaccinations before planning to conceive. Some vaccines, such as the measles, mumps, rubella (MMR) vaccine, varicella (chickenpox) vaccine, and flu vaccine, can protect against specific infections. After the MMR and chickenpox vaccine, it is advisable to wait for 3 months before attempting to conceive. The flu vaccine is routinely given in pregnancy if not yet taken and is safe to administer in pregnancy.
- Talk to your healthcare provider. Discuss your vaccination history with your healthcare provider and determine if any additional vaccines are recommended before pregnancy.
- Opt for prenatal screening. Your healthcare provider may offer prenatal screenings to detect certain infections or assess immunity to specific diseases. This can help identify any potential risks early on. For example, the Rubella antibody test (Rubella Ig G) is often performed as part of the preconception screen to check for antibody status. This allows patients who are not immunised an opportunity to be vaccinated prior to pregnancy.
- Seek advice after confirmed exposure. Speak to your health care practitioner if you have been informed by a contact as there may be ways to reduce getting infected. For example, if a pregnant lady has never gotten chicken pox before or is unsure if she has and was exposed to a confirmed contact, she should get a blood test to see if she is immune. If it is confirmed that she has no protective antibodies, an injection of Varicella Zoster immunoglobulin can help strengthen the immune system for a short time and make the infection milder and last shorter. It can be given the first 10 days from the time of contact as long as there are no symptoms.
Understanding the potential impact of various infectious diseases during pregnancy is of utmost importance for ensuring the health and well-being of both the expectant mother and the unborn child. The symptoms, risks, and potential effects on the fetus can vary from one disease to another, with some posing more severe threats than others.
While it can be daunting to consider these risks, it’s important to remember that prevention and early detection can significantly mitigate potential complications. Regular prenatal check-ups, vaccinations, proper hygiene, and avoiding contact with infected individuals can all lead to a healthier pregnancy.
Furthermore, if any symptoms are noted, it’s crucial to consult a healthcare provider promptly for diagnosis and appropriate treatment. Remember, most of these infections are manageable, especially when identified early, and do not typically result in severe outcomes with the proper care and management. In fact, most patients will have mild infections that are self limiting and are safe to recover at home. Please consult your usual family practitioner / GP for diagnosis and investigations, and update your obstetrician for further advice. As these infections may be spread to other vulnerable mothers, it is ideal to isolate yourself from other expectant mothers.
In the rare instance that the condition becomes complicated and warrants hospitalisation, please inform the triage A & E staff at the door that you need to be isolated. Please seek attention in the hospital if there is breathlessness, chest pain, severe drowsiness, vomiting, headaches, severe rash, abdominal cramps, vaginal bleeding or less fetal movements.
While filled with its unique challenges, the pregnancy journey is also one of life’s most beautiful phases. And remember, you’re not alone in this journey. Reach out to your support network, connect with other expectant mothers, and share experiences and tips. Pregnancy is a special time; you can navigate it confidently with helpful information and proactive care.
At the Dr Pamela Tan Clinic, we provide advice and intervention for pregnant women. We are here to help you overcome this health condition. You can make an appointment with us today by calling +65 6254 2878 or sending a message here.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.