German Measles in Pregnancy: Antenatal Care and Prevention

German measles, also known as rubella, is a contagious viral infection that can pose serious risks to both the mother and the unborn baby during pregnancy. While it is generally considered a mild illness in children and adults, rubella during pregnancy can lead to severe complications for the developing baby, particularly in the first trimester. This article will explore what German measles is, the potential risks during pregnancy, and how expectant mothers can protect themselves through proper antenatal care and vaccination.

What is German Measles?

Rubella, commonly referred to as German measles, is caused by the rubella virus. It is spread through respiratory droplets when an infected person coughs or sneezes. The infection typically presents with a mild fever, rash, and swollen lymph nodes, and most people recover without serious complications. However, when contracted during pregnancy, the consequences can be much more severe. The main concern with rubella in pregnancy is the risk of congenital rubella syndrome (CRS), a condition that can cause a range of birth defects, including heart abnormalities, hearing impairments, vision problems, and developmental delays. The risk of CRS is highest if a woman contracts rubella in the first 12 weeks of pregnancy, during the early stages of antenatal development. Later in pregnancy, the risks decrease but do not disappear entirely.

Symptoms of Rubella

In many cases, rubella symptoms can be mild, making it difficult to diagnose without medical testing. Common symptoms include:

• Mild fever (usually under 38.5°C)
• A rash that starts on the face and spreads to the rest of the body
• Swollen and tender lymph nodes, especially behind the ears and at the back of the neck
• Joint pain, particularly in adults
• Cold-like symptoms, such as a runny nose or sore throat These symptoms typically appear 14-21 days after exposure to the virus. If you suspect you have been exposed to rubella during pregnancy, it is essential to contact your healthcare provider immediately and discuss your antenatal care plan.

Risks of Rubella During Pregnancy

Contracting rubella during pregnancy, particularly in the early stages, can lead to significant complications. The virus crosses the placenta and affects the developing foetus, with the highest risk being in the first trimester. The main complication of rubella infection during pregnancy is congenital rubella syndrome (CRS), which can cause:

• Heart defects: Babies born with CRS may have structural heart problems, such as patent ductus arteriosus (PDA), which can lead to heart failure if untreated.
• Hearing impairments: Rubella is a leading cause of congenital hearing loss, with many babies affected by CRS being born deaf or partially deaf.
• Vision problems: Cataracts and other eye abnormalities are common in babies with CRS, leading to vision impairment or blindness.
• Developmental delays: Babies affected by CRS are at a higher risk of developmental delays, intellectual disabilities, and learning difficulties.
• Low birth weight and premature birth: Rubella can also lead to low birth weight or preterm labour. According to the World Health Organization (WHO), the risk of CRS if a woman contracts rubella in the first trimester is as high as 90%. The risk drops significantly in the second trimester but can still lead to complications such as hearing loss or developmental issues.

Prevention: Vaccination and Antenatal Care

One of the most effective ways to prevent rubella during pregnancy is through vaccination. The MMR vaccine, which protects against measles, mumps, and rubella, is typically given during childhood as part of routine immunisation schedules. If you have not been vaccinated or are unsure of your vaccination status, it is important to discuss this with your healthcare provider before becoming pregnant. Vaccination provides long-lasting immunity and is essential for protecting both the mother and the baby from rubella-related complications.

1. Vaccination Before Pregnancy

If you are planning to become pregnant, your healthcare provider may recommend a blood test to check your rubella immunity status as part of your prenatal care. If you are not immune, you can receive the MMR vaccine at least one month before trying to conceive. This ensures that your body has time to build immunity to the rubella virus before pregnancy begins.

2. Antenatal Care and Rubella Screening

As part of routine antenatal appointments, healthcare providers will often test pregnant women for rubella immunity early in pregnancy. This is typically done through a blood test during the first prenatal visit. If you are found to be immune, no further action is required. However, if you are not immune, you will need to take extra precautions to avoid exposure to the rubella virus during your pregnancy, as the MMR vaccine is not safe to administer during pregnancy. Your antenatal clinic will advise you on how to reduce your risk of exposure to rubella, particularly during outbreaks or if someone in your household contracts the virus. Pregnant women who are not immune should avoid contact with anyone who has rubella or has been exposed to the virus.

3. Antenatal Checkups and Monitoring

If you are exposed to rubella during pregnancy, it is essential to seek immediate medical attention. Your healthcare provider may order a blood test to check for the presence of rubella antibodies or perform additional tests, such as antenatal scans, to monitor the health of your baby. Regular antenatal checkups are crucial for assessing your baby’s development and detecting any potential issues early on.

Managing Rubella Exposure During Pregnancy

If you have been exposed to rubella during pregnancy or suspect that you have, the first step is to contact your healthcare provider for advice. Depending on the stage of your pregnancy and your vaccination status, they may recommend specific tests to assess the risk of infection.

1. Rubella Antibody Testing

If you have not been vaccinated or are unsure of your immunity, your healthcare provider may perform a blood test to check for rubella antibodies. There are two types of antibodies that may be present:

• IgM antibodies: These antibodies are produced shortly after infection and indicate a recent or active rubella infection.
• IgG antibodies: These antibodies provide long-term immunity and indicate past exposure to the rubella virus or vaccination. If you test positive for IgM antibodies, it means you have recently been infected with rubella. Your healthcare provider will closely monitor your pregnancy to assess the risk of congenital rubella syndrome and may recommend additional tests to evaluate your baby’s health.

2. Antenatal Scans and Foetal Monitoring

If you are diagnosed with rubella during pregnancy, your healthcare provider may recommend additional antenatal scans to monitor your baby’s development. Ultrasound scans can help detect any signs of congenital rubella syndrome, such as heart defects or growth abnormalities. In some cases, amniocentesis may be recommended to check for the presence of rubella virus in the amniotic fluid. Regular antenatal checkups are crucial for monitoring the health of both mother and baby during a rubella infection. Your healthcare provider will work with you to develop a personalised care plan based on your individual risk factors and the stage of your pregnancy.

Post-Pregnancy: Vaccination for Future Pregnancies

If you were not immune to rubella during your pregnancy and have not yet contracted the virus, it is essential to receive the MMR vaccine after giving birth. This will help protect you from future infections and prevent any risks in subsequent pregnancies. Your healthcare provider will typically recommend getting vaccinated shortly after delivery or before you leave the hospital. It is important to wait at least one month after receiving the MMR vaccine before trying to conceive again, as the vaccine contains live, attenuated virus strains that should not be introduced during pregnancy.

Complementary Antenatal Health Practices

In addition to focusing on rubella prevention, expectant mothers can support their overall health through various antenatal practices that promote relaxation and well-being during pregnancy.

1. Antenatal Yoga

Antenatal yoga can be a wonderful way to reduce stress and improve flexibility during pregnancy. Yoga helps to maintain physical fitness, which can be beneficial during labour and delivery, while also promoting mental clarity. Joining pregnancy yoga classes offers the added benefit of connecting with other expectant mothers and creating a support network.

2. Prenatal Massage

Prenatal massage offers a relaxing way to relieve muscle tension and improve circulation during pregnancy. Not only can it provide physical comfort, but it also helps to reduce stress levels, which is essential for maintaining emotional well-being. Relaxation during pregnancy can be crucial, especially when dealing with potential health concerns like rubella.

3. Antenatal Education and Support

Attending antenatal classes near me or accessing antenatal education programmes can provide valuable information about pregnancy health and prenatal care. These classes often cover a range of topics, from antenatal scans to birth preparation, offering expectant mothers the knowledge and confidence they need to navigate their pregnancy journey. Rubella, or German measles, poses significant risks to pregnant women and their babies, especially during the early stages of pregnancy. The most effective way to protect against rubella is through vaccination before conception. As part of routine antenatal care, healthcare providers screen for rubella immunity and offer guidance on how to avoid infection during pregnancy. If you are not immune, taking extra precautions, such as avoiding contact with infected individuals, is essential. Regular antenatal appointments and screenings are critical for monitoring your baby’s health and ensuring that any potential complications from rubella are detected early. Remember that pregnancy care is about more than just avoiding infections; it’s about maintaining your overall well-being. Practices like antenatal yoga, prenatal massage, and attending antenatal classes can enhance both your physical and emotional health, ensuring a smoother pregnancy journey.