Related to this topic: Leaflets | Support | Patient+ | Diagrams | UK Guidelines | Online Videos | News | Weblinks | Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Antenatal Infections and their Consequences
Certain maternal infections can have serious long-term consequences for the fetus. These include:
Rubella is a viral infection causing a pink rash, with swelling of lymph glands behind the ears and at the back of the head. There are mild constitutional symptoms and occasionally joint pain in adults.
Management
With rubella-like rash, test for rubella and parvovirus B19 (even if reported to be immune); test serum for IgG and IgM and repeat if results equivocal. Rising levels suggest recent infection (consult virologist).
Evidence of infection should be discussed with the patient with a view to considering termination.1
Prevention is by MMR vaccine in second year of life plus pre-school booster with antenatal screening for rubella susceptibility.
Consequences
If rubella is contracted within 1st 11 weeks of pregnancy there is a 90% chance of the fetus being affected.2 This falls to 20% during weeks 11-16. In weeks 16-20 there is a slight risk of deafness and after that, no increased risk.
Fetal defects associated with fetal rubella syndrome include:
- Mental handicap
- Cataract
- Deafness
- Heart defects
- Retardation of intra-uterine growth
- Inflammation of brain, liver, lungs and bone marrow
This is characterised by fever, malaise and a pruritic rash that develops into crops of maculopapules, which become vesicular and crust over before healing. The incubation period is 10 - 21 days and the disease is infectious 48 hours before the rash appears and continues to be infectious until the vesicles crust over. More than 90% of the antenatal population are seropositive for varicella immunoglobulin G (IgG) antibody, so although contact with chickenpox is common in pregnancy, primary infection is uncommon. It is estimated to complicate three in every 1000 pregnancies.3
Management
- Establish whether mother is immune.
- If any doubt request antibody levels.
- Liaise with local microbiology for advice.
- VzIg (varicella zoster immunoglobulin) may be indicated.
Consequences
In adults chickenpox is associated with greater morbidity - pneumonia (10% pregnant women), hepatitis and encephalitis.
It may also cause fetal varicella syndrome (FVS), previously known as congenital varicella syndrome or varicella infection of the newborn.
Before 20 weeks of gestation:
- Chickenpox in the first trimester does not increase the risk of spontaneous miscarriage. 3
- FVS is characterised by one or more of the following:
- Skin scarring in a dermatomal distribution
- Microphthalmia, chorioretinitis, cataracts
- Hypoplasia of the limbs
- Neurological abnormalities e.g. microcephaly, cortical atrophy, mental retardation and dysfunction of bowel and bladder sphincters
- This does not appear to be associated with adverse effects in the fetus.
- It may present as shingles in the first few years of infant life.
- Up to 50% of babies are infected, and approximately 23% of these develop clinical varicella despite high titres of passively acquired maternal antibody.
- The most severe chickenpox occurs if the infant is born within seven days of onset of the mother's rash.
In adolescence and early adulthood this causes a febrile illness with splenomegaly, impaired liver function and abnormal lymphocytes in the blood. 1
Consequences
- 1-2% of seronegative pregnant women have a primary infection during their pregnancy, a small proportion undergo reactivation.
- Effect on fetus is more severe from a primary infection:
- Approximately 1% die at or soon after birth
- 4% have severe cytomegalic disease; most frequent signs are:
- Low birth weight
- Hepatosplenomegaly
- Jaundice
- Thrombocytopenia
- Petechiae and/or purpura
- Microcephaly
- Intracranial calcifications
- Choroidoretinitis
- Deafness
- Speech defects
- Mental retardation, which may appear later
- 15% appear normal, but hearing defects and possible mental retardation becomes apparent later in life.
Infection with the parasite Toxoplasma gondii, a coccidian, with the cat as its definitive host.
Acute acquired toxoplasmosis presents with fatigue lasting for several weeks, headache, muscle pain, low-grade fever for one or several weeks. Usually sub-clinical with lymphadenopathy affecting the posterior cervical, suboccipital, retroauricular or submental nodes. These can be painful and tender for 1-2 weeks and rarely larger than walnuts being small, well defined and mobile.4
Management
Treat with spiramycin throughout pregnancy with regular ultrasound examination of fetus.
Consequences
1/3 infants become infected if mother becomes infected during pregnancy, especially in later pregnancy. There are many different forms of presentation.
- Systemic disease of neonate:
- Rash
- Jaundice
- Thrombocytopenic purpura
- Hepatosplenomegaly
- Pneumonia
- Progressive uveitis
- Neurological disease:
- Hydrocephalus; due to stenosis of the duct of Sylvius requiring shunt
- Microcephaly
- Microphthalmia
- Retinochoroiditis
- Cerebral calcification
- Mild disease; small area of retinochoroiditis or slight cerebral calcification without signs of brain damage.
- Sub-clinical; occurs in 70% of infected babies.
- Relapsing; retinochoroiditis as flare-ups can occur at any age, most cases in a previously intact retina.
PID includes infections of the upper genital tract and commonly caused by sexually transmitted infections. Chlamydia has been identified in 52% of cases of confirmed PID and gonorrhoea in 14%.
Presents with lower abdominal pain and tenderness. Also possibly dyspareunia, abnormal vaginal bleeding and/or discharge. Many cases are asymptomatic.
Management
Pregnant women with PID should be admitted for IV antibiotics.5
Consequences
PID is associated with increase in pre-term delivery, maternal and fetal morbidity.
Can also transmit ophthalmia neonatorum which is potentially sight threatening.
Virus infections producing patches of small, fluid-filled vesicles that burst to form shallow, painful ulcers. Initial infection is followed by recurrences and both occur as self-limiting episodes.6
Management
- Main risk of transmission is during primary infection when oral aciclovir should be considered in first 6 months of pregnancy.
- After that and in cases of recurrence with active genital lesions, may need to offer caesarean section.
Consequences
Neonatal infection is rare in UK but can have serious effect upon the fetus if it disseminates (e.g. encephalitis).
Infects T-lymphocytes, macrophages and monocytes with the CD4 receptor. It attacks the immune system, usually over many years, and reduces its effectiveness until an AIDS-defining illness occurs. HIV transmission to the baby is significant problem especially in the developing world.
Maternal transmission can occur via the following routes:7
- In utero by passage of virus across the placenta
- During delivery from blood and placental fluids
- From breast milk
Management
Transmission can be reduced by:8
- Maternal treatment with antiretrovirals
- Caesarean section
- Avoidance of breast feeding
Consequences
Untreated, most maternally infected children die by age 10 years.
Asymptomatic bacteriuria is very common in pregnant women because of the altered dynamics of the urinary tract. If untreated, this frequently progresses to acute cystitis (1-2%) and/or pyelonephritis.9 The symptoms of acute cystitis are the same as in non-pregnant women:
- Frequency
- Urgency
- Cloudy, smelly urine
- Dysuria
Those of acute pyelonephritis are:
- Pyrexia
- Rigors
- Flank pain
- Nausea & vomiting
- Headache
- Frequency & dysuria
Management
Urine should be tested by dipstick at first antenatal visit. Confirmation is with urine microscopy and culture.
Treat with trimethoprim, a cephalosporin or nitrofurantoin (except where otherwise contraindicated). In recurrent UTI, consider prophylactic nitrofurantoin but stop before delivery.
Consequences
UTI increases the risk of premature labour and low birth weight.
Document references
- Tookey PA & Logan S in Oxford Textbook of Medicine, 4th Edition. Eds; Warrell DA et al. OUP 2003.
- Health Protection Agency. General Information-Rubella
- Chickenpox in pregnancy, Royal College of Obstetricians and Gynaecologists (September 2007)
- Couvreur J and Thulliez Ph in Oxford Textbook of Medicine, 4th Edition. Eds; Warrell DA et al. OUP 2003.
- Pelvic inflammatory disease, Clinical Knowledge Summaries (2006)
- Herpes simplex - genital, Clinical Knowledge Summaries (2005)
- Frye R, Rivera-Hernandez D; eMedicine, HIV Infection, 2005; Overview of congenital and paediatric HIV infection
- Management of HIV during pregnancy, Royal College of Obstretricians and Gynaecologists (2004)
- Urinary tract infection (lower) - women, Clinical Knowledge Summaries (2006)
Internet and further reading
- Health Protection Agency; Guidelines on the management of, and exposure to, rash illness in pregnancy (including consideration of relevant antibody screening programmes in pregnancy) 2003
- RCOG. Management of Genital Herpes in Pregnancy. Green top Guideline.; 2001
DocID: 4034
Document Version: 21
DocRef: bgp192
Last Updated: 18 Jan 2007
Review Date: 17 Jan 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineInformation leaflets related to this topic (^ top of page)
Healthy Start
Maternity Benefits
Pregnancy - Planning to Become Pregnant?
Pregnancy - Planning to Become Pregnant? - A summary
Pregnancy - Pre-Eclampsia
Pregnancy - Routine Screening Tests
Pregnancy and Alcohol
Pregnancy and Caffeine
Pregnancy and Diet
Pregnancy and Dyspepsia
Pregnancy and Employment
Pregnancy and Folic Acid
Pregnancy and High Blood Pressure
Pregnancy and Medication
Pregnancy and Rubella
Pregnancy and Sickness and Vomiting
Pregnancy and Smoking
Pregnancy and Street DrugsPatient Support related to this topic (^ top of page)
AIMS - Association for Improvements in Maternity Services
Antenatal Results and Choices - ARC
BPAS - British Pregnancy Advisory Service
CAREconfidential
Centre for Pregnancy Nutrition
Disability, Pregnancy & Parenthood International
Health Healthy Start Scheme
Life (pregnancy support)
Lifeline Pregnancy Counselling and Care
Multiple Births Foundation
National Childbirth Trust
Perinatal Illness UK
Royal College of Midwives
Society for the Protection of Unborn Children
Tiny Tickers
UK Epilepsy and Pregnancy Register
WellBeing (women's health)
Women's Health ConcernMedical reference articles in PatientPlus related to this topic (^ top of page)
Anaemia In Pregnancy
Antenatal Care
Antenatal Screening for Down's Syndrome
Anti-D (Rho) Immunoglobulin
Booking Criteria and Home Delivery
Congenital Infections in Neonates
Congenital Rubella Syndrome
Flying with Medical Conditions
Gravidity and Parity Definitions (and their implications in risk assessment)
Hypertension in Pregnancy
Minor Symptoms Of Pregnancy
Physiological Changes In Pregnancy
Renal Disease in PregnancyDiagrams related to this topic (^ top of page)
Kickchart (diagram)UK guidelines related to this topic (^ top of page)
Guidelines on Pregnancy
Guidelines on Antenatal CareOnline videos related to this topic (^ top of page)
Online videos on Pregnancy
Online videos on Antenatal CareRecent news items related to this topic (^ top of page)
Smokers who give up during pregnancy have good-natured children, claims study
Alcohol ban advised for pregnancy
Parents pass on breech baby genes
Breech deliveries inherited
The gamble of having a home birth
Midwife shortage hits home birthsLinks to other selected websites related to this topic (^ top of page)
Antenatal Care
Pregnancy and ChildbirthOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)

Books related to this topic (^ top of page)
Antenatal Care
Healthy Pregnancy
National Childbirth Trust Book of Pregnancy, Birth and Parenthood
New Pregnancy and Birth Book
Pregnancy & Childbirth Answers (Complete)
Pregnancy (Blooming): Surviving and thriving for him and her
Pregnancy (Healthy)
Pregnancy (Understanding)
Pregnancy : British Medical Association's Family Doctor Series
Pregnancy and Birth Book (New)
Pregnancy and Post Natal Exercise video from the BBC
Pregnancy for Dummies
What to Expect the First Year
What to Expect When You're Expecting
Which Tests for My Unborn Baby? Ultrasound and Other Prenatal Tests
Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
