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.

Chicken-pox and shingles in Pregnancy

What should I do if I am exposed to chicken-pox during pregnancy?

You need to have your immunity checked. You will probably know whether you have had chicken-pox earlier in life. If that is the case, then you are in the clear. Ninety per cent of all women of child-bearing age are immune, by virtue of previous infection, and therefore exposure during pregnancy poses no risk to their babies. This of course leaves one in ten who are susceptible.

If, on checking immunity, one is found to be susceptible, what then?

The potential effects on the fetus depend on the gestation.

The known effects to the baby will occur in about 10% of babies if the infection is in the first twelve weeks of gestation.

The potential damage is less if the infection occurs later. The exception to this is if the baby is born within the period when the infection is still active.

What effects do infected fetuses suffer from?

It could be a few or more of these:

large patches of skin scarring
small head
eye complications, including cataracts and scarring inside the eye
paralysis of limbs
deformed, even absent fingers and/or toes

convulsions.