Generality
Rubella in pregnancy is a exanthematous disease which, if contracted during gestation, can be very dangerous for the health of the unborn child .
Once transmitted from the mother to the embryo or fetus, in fact, the infection can cause spontaneous abortion, intrauterine death and malformations of varying severity (including visual defects or complete blindness, deafness, congenital heart disease and delayed physical and mental development) .
Rubella in pregnancy involves particularly serious risks if contracted in the first 3-4 months of gestation (especially within sixteen weeks ). In the second trimester of gestation, the risk of a fetal infection is reduced, but still remains significant.
The problem does not exist if the woman was vaccinated or became ill with rubella in the past, obtaining immunity.
To check for the presence of antibodies against the virus, so be sure to have previously contracted the infection, women should undergo, before conception, a specific laboratory test, called Rubeo test . If the outcome of this test is negative, in order not to take risks and protect yourself from rubella during pregnancy, vaccination is recommended, at least 3-6 months before conceiving a child.
What's this
Rubella is one of the most famous exanthematic diseases typical of childhood. Usually, the course is benign and the symptoms are mild, without particular consequences for health. Once exceeded, the rubella leaves a permanent immunity, therefore it is no longer possible to get sick.
However, if the infection is contracted for the first time in pregnancy, it can be transmitted to the fetus .
What is Rubella in Pregnancy?
Rubella is a serious disease, if contracted for the first time during pregnancy, that is when it affects women who have not been vaccinated or who have not been previously exposed to the infection. In this case, in fact, there is a real probability that the virus can be transmitted to the fetus through the placenta and cause serious damage . The most common and severe fetal manifestations of congenital rubella are sight defects, deafness, cardiac malformations and mental retardation.
Causes
Rubella is an infectious disease of viral origin that mainly affects children, especially between the ages of 5 and 14. The disease has an incubation period of 14-23 days and is contagious in the week preceding the onset of the rash and for the following 4 days.
When the infection is contracted for the first time during pregnancy, the viral agent can overcome the placental barrier, infect the fetus and cause very serious consequences : from possible malformations in the unborn child ( congenital rubella syndrome ) to the risk of an abortion spontaneous .
If the woman has contracted rubella in the past, obtaining immunity, or has been vaccinated, the possible contact with the virus does not entail risks for the fetus, except in very rare cases.
To remember
Acute primary infection and rubella vaccination determine permanent immunity .
How can you get the infection?
Rubella is a very contagious disease . The Rubella virus that is responsible for it is transmitted mainly by air (through droplets of saliva emitted by coughing, sneezing or simply speaking) or direct contact with the secretions coming from the nose, mouth and pharynx of an infected person.
Furthermore, during pregnancy, the rubella virus can overcome the placental barrier, so it can be transmitted to the embryo or fetus.
Rubella in Pregnancy: how it is transmitted to the fetus
Rubella in pregnancy can be transmitted from the future mother to the embryo or to the developing fetus through blood circulation .
The virus that is responsible for it, in fact, can overcome the placenta, reach the fetal circulatory system and rapidly multiply in the embryonic tissues, causing chromosomal damage and alterations of the organogenesis .
The congenital infection and the possible consequences of the disease are closely connected to the moment in which the pregnant woman contracts the disease. In particular, if rubella is contracted during the first 10 weeks of pregnancy, the estimated risk of consequences for the fetus is up to 90%.
The chances of the child developing complications are reduced to 30%, if the infection occurs between the 11th and 16th week . In infections contracted beyond the 17th week of pregnancy, a risk of congenital deafness was predominantly recorded in the newborn. In fact, beyond the first trimester of gestation, the placenta performs a protective action, so it is more rare for fetal infection to occur during this period.
To remember
Transmission of the infection may occur throughout the gestational period, but the greatest risk of transplacental passage occurs in the first 16 weeks of pregnancy.
Symptoms and Complications
Rubella in Pregnancy: incubation and infectiousness
- Rubella in pregnancy has an incubation period ranging from a minimum of 12 to a maximum of 23 days, after exposure to the infectious agent.
- The period of infectiousness goes from a week before to 4 days after the appearance of the exanthem. It should be noted that rubella, however, does not always present with well-defined signs or symptoms, so infections can go completely unnoticed.
- An infant who has contracted the infection during intrauterine development can remain infectious even for months after birth .
How does it manifest itself?
Rubella is generally characterized by a rash, that is, a rash in which many small spots appear, slightly raised to the touch, of a pink or pale red color . In about 20-50% of cases, however, this event may be completely lacking. The rash of rubella is similar to that of measles, but compared to the latter, the spots are smaller, less red, more spaced from one another and do not tend to flow together. The rash spreads from the face and neck, then affects the rest of the body, before disappearing within 3-4 days.
Other symptoms include:
- Fever not high ;
- Enlarged lymph nodes at the base of the neck ;
Other manifestations are non-specific and include:
- Headache;
- Articolar pains;
- Loss of appetite;
- Decreased white blood cells.
Rubella is generally negligible, since it has a benign course and does not lead to complications: the disorders resolve, without consequences, at the latest within a couple of weeks. However, if contracted during pregnancy, the virus responsible for rubella can have very serious consequences, such as miscarriage and various fetal malformations .
To remember
Rubella during pregnancy produces the most serious damage, as the gestation period in which the woman finds herself at the time when she contracted the disease is earlier.
Rubella in pregnancy: risks to the fetus
Rubella in pregnancy exposes the unborn child to serious consequences, especially if the infection occurs within the first trimester .
At the beginning of pregnancy, the possible damage to the fetus includes:
- Miscarriage;
- Death in utero;
- Ear defects (sensorineural deafness);
- Eyesight problems, including cataracts, microphthalmia, glaucoma and chorioretinitis;
- Cardiac malformations (patent ductus arteriosus, pulmonary stenosis, interatrial and interventricular defect);
- Brain damage with microcephaly and various forms of mental retardation;
- Damage to the liver and spleen;
- Bone alterations (defects of osteogenesis and ossification in the metaphyses of long bones);
- Growth delay;
- Hematological disorders (haemolytic anemia, thrombocytopenic purpura, etc.).
After the first 16 weeks, the probability of transplacental passage of the virus is always lower and, if the infection reaches the child, there remains a generic risk common to other viral infections (fetal distress, growth retardation, etc.) that require careful monitoring.
Diagnosis
The diagnosis of rubella in pregnancy is mainly of a clinical nature and is based on investigations aimed at isolating the responsible virus and searching for the antibodies against the serum in the serum, so it is aimed at ascertaining the immunity of the future mother. The test is called Rubeo test and confirms if the woman has contracted the infection in the past or the disease is ongoing.
In Italy, the Rubeo test is included in the infectious screening tests provided by the Ministry of Health and offered free of charge (Ministerial Decree of 10 September 1998 (GU 20/10/98, n. 245).
Rubeo Test for Pregnant Rubella
When women who wish or become pregnant do not know that they are immune to rubella (since, for example, they do not remember having been vaccinated or become sick as a child), they can undergo a screening test (Rubeo test).
This exam is carried out through a simple blood sample and, in Italy, it is included in the free checks of the first trimester of pregnancy (within the 13th week).
The purpose of the Rubeo test consists of:
- Check the immunity of the future mother;
- Identify women susceptible to infection.
If the outcome is positive, it is important to know that rubella is a exanthematous disease that gives permanent immunity.
Women not vaccinated or with Rubeo negative test, therefore not immune to rubella in pregnancy, are proposed to repeat the test within the 17th week of gestation, a period beyond which the risks for the fetus are significantly lowered.
For further information: Rubeo Test - Interpretation of Results »Treatment
How is Rubella in Pregnancy treated?
Currently, there is no specific therapy for rubella in pregnancy or to reduce maternal-fetal transmission. In other words, you have to wait for the disease to take its course. Meanwhile, bed rest is recommended, along with a light, liquid-rich diet.
Only in particular risk situations will the gynecologist evaluate the opportunity to resort to passive immunization, administering specific anti-rubella immunoglobulins, to strengthen the immune system and reduce, in case of infection, the probability that it is transmitted to the fetus.
Prevention
Vaccination is the only means of defending yourself against rubella during pregnancy and the consequences on the unborn child. When planning the conception, therefore, it is good to carry out the Rubeo test and, in case of negativity of the outcome (therefore, of the absence of specific antibodies), the indication is to undergo the vaccine.
Active immunization against rubella is achieved through inoculation of live attenuated viruses, unable to cause the disease, but able to stimulate the production of antibodies that are effective against infection. At least three to six months must elapse between the prevention of rubella and the onset of pregnancy (conception).
