“It is difficult to detect all cases of maternal infection during pregnancy,” notes Dr Tony Tan, a specialist in obstetrics and gynaecology at Raffles Women’s Centre, Raffles Hospital. “Some are symptomatic but many could be asymptomatic. Depending on the timing of the infection, the risk of foetal damage is usually worst when it is infected in the first trimester.”
Dr Tan also notes that most cases of foetal infection are only detected if there are structural abnormalities at the detailed 20-week scan or a later scan done by a sonographer or a foetal medicine specialist.
The expectant woman may need further testing to check if there was a recent maternal infection. She may also need an amniocentesis to find out her foetus has been infected. So, it’s wise to get your rubella and chickenpox jabs before trying for a baby.
“Many obstetricians are now offering pertussis (whooping cough) and influenza (flu) vaccines to pregnant women during pregnancy,” Dr Tan points out. “This would reduce the risk of the baby having whooping cough and flu in the first few months as whooping cough could be a very serious infection.”
Apart from getting immunised, a pregnant woman can reduce the risk of serious problems for herself and baby by maintaining good personal hygiene and taking other precautions. These include observing strict handwashing and sanitising habits, staying away from infected people and eating thoroughly cooked food.
Here are seven infections you might catch during pregnancy that might pose a risk to baby and what you can do about it.
Apart from getting immunised, a pregnant woman can reduce the risk of serious problems for herself and baby by maintaining good personal hygiene and taking other precautions.
WHAT IS IT? You may contract toxoplasmosis if you’re infected with the toxoplasma gondii parasite, one of the world’s most common parasites.
HOW DOES IT SPREAD? Toxoplasmosis may be contracted by:
1. Eating undercooked or contaminated meat or drinking contaminated water.
2. Eating food that’s been contaminated by dirty knives, utensils, cutting boards and other foods that have had contact with raw, tainted meat.
3. Accidentally swallowing the parasite through contact with cat faeces that contains toxoplasma. This usually happens when cleaning an infected cat’s litter box or ingesting anything that has come into contact with cat faeces.
4. Accidentally ingesting contaminated soil by not washing hands after gardening or eating unwashed fruits or vegetables.
RISKS AND MANAGEMENT Maternal infection may be mild, with flu-like symptoms or it could even be asymptomatic sometimes. If the maternal infection occurs in the first trimester, it may sometimes infect the foetus via the placenta. In such cases, the risk of complications is high and may damage the brain, eyes, placenta and restrict growth. Dr Tan says medications can be given to reduce the spread of the disease to the foetus.
#2 Parvovirus b19 infection
WHAT IS IT? Also known as slapped-cheek disease because of the distinctive face rash, this is a common and highly-contagious viral disease that’s also known as fifth disease. In most people, a parvovirus infection is mild and requires little treatment. However, parvovirus b19 infection in certain pregnant women can lead to serious health problems for the foetus.
HOW DOES IT SPREAD? Early signs and symptoms may include fever, an upset stomach, headache, runny nose and joint soreness (hands, wrists, knees and ankles). Parvovirus b19 spreads through respiratory secretions ― such as saliva, sputum or nasal mucus ― when an infected person coughs or sneezes. The virus can also spread through blood or blood products. A pregnant woman who is infected with parvovirus b19 can pass it to her baby.
RISKS AND MANAGEMENT If the foetus is also infected, it may briefly suppress its bone marrow development, giving rise to anaemia. As a result, the foetus could swell with excess fluid in the skin and other body cavities, and may have severe heart failure and even die. Dr Tan says there is no medication that can help. However, the foetus should be monitored closely for foetal anaemia and heart failure. A transfusion of blood to the foetus through a needle inserted into mummy’s uterus may reverse the anaemia and heart failure and prevent a stillbirth.
#3 Cytomegalovirus (CMV)
WHAT IS IT? A common virus that infects people of all ages. Once a person contracts CMV, it remains in the body and can be reactivated. A person can also be re-infected with a different strain of the same virus.
HOW DOES IT SPREAD? CMV is spread by direct contact of bodily fluids, such as saliva, blood, urine, semen, vaginal fluids and breastmilk. So, breastfeeding, blood transfusions, organ transplants and sexual contact are possible modes of transmission.
RISKS AND MANAGEMENT Expectant mothers can have more serious symptoms affecting the eyes, lungs, liver, oesophagus, stomach, and intestines. She can also pass the virus onto her baby. Although most babies don’t have health issues, some develop complications like damage to the brain, eyes and placenta, suffer hearing loss and see restricted growth. Dr Tan says antiviral medications are being studied to determine if they would be useful.
WHAT IS IT? Chickenpox is caused by the contagious varicella zoster virus. Symptoms include high fever, headache and blisters, which can show up anytime from 10 to 21 days.
HOW DOES IT SPREAD? Infected people spread the virus by touching someone after touching the blisters or coughing/sneezing onto their hand. They also release the virus it into the air whenever they sneeze, cough or even breathe. The virus can also spread from direct contact with the blister fluid.
RISKS AND MANAGEMENT If the mother is infected in the first 20 weeks of pregnancy, she has an additional 2 per cent risk of developing foetal varicella syndrome (fvs). This means that her baby may be born with serious abnormalities such as scarring of the skin, as well as abnormalities of the brain, eyes and limbs.
According to Dr Tan, if the expectant mother has no prior history of chickenpox infection or chickenpox vaccination, and has been exposed to someone suffering from chickenpox, a passive antibody can be given to prevent the mother from developing the virus.
Usually, a test to check the mother’s blood for the chickenpox antibody is done before the passive antibody is given as most women may already have immunity without realising it. Acyclovir, an antiviral medication, can be given if the mother has chickenpox to reduce her risk of suffering severe complications like pneumonia. Unfortunately, there’s no treatment for the foetus.
If the mother is infected [with rubella] in the first trimester, it could result in a high risk of foetal abnormalities to the heart, brain, eyes and growth restriction.
# 5 Rubella (German measles)
WHAT IS IT? A contagious infection caused by the rubella virus. Symptoms include a low-grade fever, sore throat and a rash that starts on the face and spreads to the rest of the body.
HOW DOES IT SPREAD? Rubella spreads when an infected person coughs or sneezes. Also, an infected pregnant mother can pass it to her developing baby, causing serious harm. A person with rubella may spread the disease to others up to one week before the rash appears, and remain contagious for up to seven days after.
RISKS AND MANAGEMENT If the mother is infected in the first trimester, it could result in a high risk of foetal abnormalities to the heart, brain, eyes and growth restriction. There is no treatment for rubella, says Dr Tan. Fortunately, as school children routinely get the rubella vaccination, it is rare to find rubella infection in adults these days.
WHAT IS IT? Zika is generally a mild disease. It may cause a viral fever similar to dengue or chikungunya, with skin rashes, body aches and headaches. Many people infected with the zika virus do not even develop symptoms.
HOW DOES IT SPREAD? The virus is transmitted to others primarily through the bite of an infected Aedes mosquito.
RISKS AND MANAGEMENT If the mother is infected in the first two trimesters, there is a risk that her foetus might suffer microcephaly (an underdeveloped brain). Dr Tan says there is no treatment for Zika.
#7 Hepatitis B
WHAT IS IT? It’s a liver infection caused by the hepatitis b virus (hbv) that can cause chronic infection and risk of death from cirrhosis and liver cancer. Some people have acute illness with symptoms that last several weeks, including jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small number of people with acute hepatitis can develop acute liver failure, which can lead to death.
HOW DOES IT SPREAD? The virus is transmitted through contact with the blood or other body fluids of an infected person. Some mothers are silent hepatitis b carriers. It is commonly spread by the mother during pregnancy and through the birthing process. The hepatitis b vaccine is the best way to prevent infection.
RISKS AND MANAGEMENT Hepatitis b can be passed on from the expectant mum to the baby, hence, a routine blood test is offered to all pregnant women to detect hepatitis b. An infected child is likely to be a hepatitis b carrier for life, and may develop liver damage or liver cancer later in life. Dr Tan says a blood test can be done at 28 weeks to check the mum-to-be’s viral level. If the level is high, antiviral medications can be given to the mother to reduce it with the aim of minimising the spread from the mother to the baby. After birth, all babies are given hepatitis b jabs.
In case you missed these…