✓ Rubella in pregnancy: what risks are there, the precautions to avoid it

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Rubella in pregnancy

Rubella is a generally harmless contagious viral disease. If contracted during pregnancy, however, it becomes dangerous, because it can cause spontaneous abortion, intrauterine death or serious fetal malformations. For this reason, before conceiving a child it is best to check if you are immune from the disease: if you are not, you can protect yourself and your future baby with a vaccination.

What is Rubella

"Rubella is an infectious disease caused by a rubivirus, from the group of togaviruses, and it is easily contagious because it spreads through respiratory droplets spread into the air by the patient or direct contact with nasal secretions "explains the gynecologist Annunziata Marra, head of the territorial gynecological assistance unit of Lecce.

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Rubella in children: photos to recognize it

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Rubella is a viral infectious disease with a measles-like rash. It consists of pink, flat spots, which usually cover the whole body the first ...

Symptoms of rubella

"The symptoms aren't particularly obvious, so much so that it often goes almost unnoticed". According to the rubella fact sheet of the Epidemiology Portal of the Higher Institute of Health, almost half of infected people do not show any symptoms: in the other cases there may be:

a rash, with small pink spots that appear first behind the ears, then on the forehead and all over the body,
mild fever and headache,
slight swelling of the lymph nodes,
joint pain and red, watery eyes.

All this lasts a maximum of ten days.

Solo there can rarely be complications, such as encephalitis or otitis, more common if the patient is an adult. Rubella, moreover, is a typical childhood disease, like measles, chicken pox and whooping cough.

No problem, then? Not at all. Because rubella can be very dangerous if contracted during pregnancy by women who have never been in contact with the virus before, and therefore have never been infected or vaccinated. In this case, the consequences for the fetus can be very serious.

Rubella in pregnancy, risks

Until when is rubella dangerous? If you contract rubella during pregnancy, the consequences for the fetus can be quite serious, especially if the infection occurs before the sixteen weeks of pregnancy.

In this case, they can occur miscarriage, intrauterine death and severe malformations which collectively go under the name of congenital rubella syndrome. These malformations can affect various organs such as the eye, with the risk of cataracts and glaucoma; the ear, causing deafness; the heart and large blood vessels and the nervous system, with risk of mental and motor retardation. According to the Higher Institute of Health, in case of infection in the first trimester the risk of consequences for the fetus is 90%.

"If maternal infection occurs after sixteen to twenty weeks of pregnancy the consequences are usually much less severe compared to the infection contracted in the first months "underlines Marra.

Can you get sick more than once?

The good news is, once contracted, rubella leaves you with lifelong immunity: for this reason, those who have already had it in the past - or have been vaccinated against the disease - in view of a pregnancy can rest assured. "In reality new infections are always possible, but they are harmless"explains Marra. In other words, those who are protected because they have already had the infection or received the vaccine, run no risk even if they were to become infected again during a pregnancy.

If you are not immune to rubella, the only way to plan a peaceful pregnancy is to get vaccinated!

How to know if you are immune or not: the rubeo-test

If you are thinking of expanding your family and you know you have not had the rubella vaccine, this would be ideal find out, before conception, if you have already had the disease and therefore you are immune, or not. To do this, just perform the rubeotest, a simple blood sample that allows you to evaluate whether or not you have antibodies against the disease. The test is one of those offered free of charge by the National Health Service.

The rubeo-test detects the presence of two types of antibodies or immunoglobulins:

IgM, are the immunoglobulins that are produced in the acute stage of the disease, so they are immediately detectable in the blood. They remain active for about 2 months, after which their values fall below the limit threshold and the test is negative (although sometimes there are cases of persistence of IgM);
IgG, are the 'memory' antibodies, which occur 1-2 weeks after becoming infected but remain positive for life.

How to read the Rubeo test values

If both antibodies are negative, it means that there has never been contact with the virus: before thinking about conception, think about the vaccine!
If the IgM and IgG are positive it means that the infection is recent (very recent if the IgG are still negative): it is advisable to consult the gynecologist, who will probably recommend delaying the search for pregnancy for some time (one-two months).
If the IgM is negative but the IgG is positive, it means that there was an infection but in the past and that now we are immunized: go ahead. "It is the most frequent situation and also the most reassuring" comments the gynecologist, head of the OU of obstetrics and gynecology at the Luigi Sacco Hospital in our city.

How to get the rubella vaccine

Getting to a pregnancy with a negative rubeo test is nowadays more and more difficult, both because the test is prescribed between routine preconception examinations and therefore you have time to get vaccinated, and because, in terms of vaccinations, there has been an important recovery of 18-24 year old girls thanks to a vaccination plan for adolescence. In the future, things should improve further, because the rubella vaccine is included in the vaccination calendar: for new born, a first dose is recommended around 12-15 months of age, and a booster around 5-6 years of age.

In any case, if you are not immune to rubella, the only way to plan a peaceful pregnancy is to get vaccinated against the disease. "The vaccine, which is injected under the skin, is combined with those against measles and mumps and is based on strains of live attenuated viruses," explains Marra. "For this reason, as a whole precaution is contraindicated if pregnancy is already in progress and therefore it is recommended to check the state of non-pregnancy before being vaccinated ".

After the vaccine, the documents of the Higher Institute of Health advise to wait at least one month before trying to conceive a baby.

Read also: Vaccinations before becoming a mother

Advice for those who are not immune and have not had the vaccine

If for various reasons you arrive at pregnancy without having the vaccine and with a negative Rubeo-test, you will have to take every precaution so as not to expose yourself to contagion especially in the first 16-20 weeks.

Based on your condition and the work activity you carry out - for example if you work in school communities or in general with children - the gynecologist will be able to evaluate the opportunity to undergo prophylaxis with specific hyper-immune gamma globulins which enhance the immune defenses and reduce the probability of trans-placental passage of the virus.

And if you already have a child who needs to undergo the rubella vaccination? Are there any special precautions to be observed? "After the vaccine, the child eliminates the virus in the environment for a period ranging from 7 to 28 days, however in the literature no cases of contagion have ever been reported following vaccination" replies the gynecologist. In any case, it is better to inform the vaccination center of your pregnancy.

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