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Rubella in pregnancy: how this disease affects the baby and why it is so important to prevent it through vaccination

Chickenpox and rubella are two extremely dangerous viral diseases if they are contracted during pregnancy , as the infection passes through the placenta and can compromise the correct development of the baby and even endanger its life.

If a few months ago we talked about what getting chickenpox during pregnancy can mean, today we are going to explain how rubella affects pregnancy and why it is so important to prevent it through vaccination.

What is rubella?

Rubella is a disease caused by a virus that is spread through the air or by direct contact. Symptoms are normally mild , with general malaise, headache, and fever being common, as well as a skin rash similar to that seen with measles.

It is a very contagious disease , since the infected person can be contagious even a week before the symptoms appear (that is, before they know they have this disease) and up to a week or two after they have disappeared.

Although the rubella vaccine confers 95% protection, according to a report published by the Microbiology Service of the General University Hospital of Elche, it is estimated that between 2-3% of adults are susceptible to infection , especially dangerous in the case of pregnant women.

Complications of rubella in pregnancy

Rubella in pregnancy can cause abortions or the ‘congenital rubella syndrome’, seriously affecting all the organs of the fetus, especially depending on the time of pregnancy when the infection occurs.

The lesions presented by babies born to mothers who have been infected with rubella during pregnancy range from significant delays in growth and development, to microcephaly, cataracts, hepato-splenomegaly alterations, heart defects, deafness or meningoencephalitis, among others.

  • If the infection occurs in the first trimester, the possibility of transmitting it to the baby is 90%, according to the WHO
  • If the disease is contracted between the 13-16 week of pregnancy, lesions occur in 16.7% of babies
  • If contracted between weeks 17-20, 5.9% of babies will have birth defects
  • If contracted after week 20, the percentage decreases to 1.7%

There is no cure for congenital rubella syndrome in the baby , although the specific symptoms it presents can be treated, depending on its degree and type of affectation. In this sense, it might be necessary to put yourself in the hands of ophthalmologists, hearing specialists, gastroentorologists, cardiologists, hematologists …

Treatment of the pregnant woman who contracts rubella

If the woman becomes infected with rubella during pregnancy , the doctor should inform her in detail of the risks this poses to the fetus. Diagnosis of infection in the baby can be made in two ways:

  • Before birth , by the presence of specific IgM antibodies in the fetal blood (this test has its maximum performance in the 22nd week of gestation), although a negative result does not rule out infection. A study of the viral RNA of the amniotic fluid or fetal blood can also be done.

  • After birth , due to the presence of antibodies in the blood. In infants with persistent rubella-specific IgG antibodies after 6 to 12 months, it also suggests congenital infection.

In any case, there is no specific treatment to avoid congenital rubella . The only existing treatment is symptomatic, aimed at alleviating the mother’s symptoms. In cases where the pregnant woman has been exposed to the disease without immunity early in pregnancy, a gamma globulin treatment may be indicated, although its beneficial effects are unclear.

What is the incidence of the disease in pregnancy?

Before the vaccine was commercialized in 1969, up to four children in every 1,000 live births were born with congenital rubella syndrome . But little by little the incidence has been falling thanks to vaccination.

Thus, in the United States, rubella was declared eliminated in 2004, and except for a few isolated cases, no cases of congenital rubella have been seen in babies. In our country, the immunity rate against rubella virus in adult women is above 90%, reaching up to 98% in some geographical areas.

In any case, it is important to note that the rubella vaccine was not introduced systemically in Spain until 1980 , reaching a vaccine coverage of over 80% in 1985. Therefore, there are still women of childbearing age who were not vaccinated in their childhood against rubella and that if they have not passed the disease, they are at risk if they become pregnant.

According to the WHO, the highest risk of congenital rubella syndrome is registered in countries in which women of childbearing age do not have immunity against the infection, either because they have not had the disease or because they have not been vaccinated.

Rubella vaccine is the best prevention

The rubella vaccine is the most effective measure to prevent this disease , and fortunately it is included in the vaccination schedules of most countries in the world.

The rubella vaccine is part of the MMR, along with measles and mumps, and is administered in two doses: a first dose at the age of 12 months, and a second booster dose between three and four years.

If you are of childbearing age and you do not know if you received the vaccine in your childhood and you do not remember having passed the disease, see your doctor when you plan your pregnancy. Through a serological analysis, it will determine the presence or absence of antibodies in the blood. If you do not have antibodies, you should get vaccinated, taking into account that you will not be able to get pregnant within four weeks after receiving the vaccine .

Being a live virus vaccine, the rubella vaccine is contraindicated during pregnancy.

Photos | iStock

Via | Clinical practice guide for care in pregnancy and the puerperium – Ministry of Health, WHO, Medical Writing, CDC – Rubella and pregnancy

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