Rubella and Pregnancy

Rubella, also called German or three-day measles, isn’t generally considered a problem for most people. Aside from a mild fever, rash and fatigue, our immune systems typically fight the virus off in a few days. Additionally, according to data from the CDC, over 90% of children in the U.S. are vaccinated by 24 months. 

If you’re pregnant or immunocompromised, rubella can cause serious long-term complications, including heart issues. Contracting rubella during pregnancy increases the chances of miscarriage or congenital disabilities. The best protection is knowing your immune status and getting vaccinated before conception. However, that may not be an option, so you should understand the risks of rubella for pregnant women and what to do to protect yourself. 

What is Rubella?

Rubella is a contagious disease caused by a virus. It is spread via person-to-person contact or when an infected person coughs or sneezes, like the common cold or flu. Although it’s often referred to as German measles, they don’t originate from the same virus. It’s not dangerous for most of the population, as most of the U.S. is vaccinated, and the length and intensity of the disease is fairly mild. Before the rubella vaccination was widely adopted, outbreaks were commonplace across the country and very dangerous for children, people with a compromised immune system, the elderly and pregnant women. 

Even though rubella is no longer a public health issue in the U.S., there are still more than 17,000 cases around the world each year, and people can unknowingly bring the virus into the country.

Rubella Signs and Symptoms

Signs of rubella look differently for children vs adults. For both, the illness is usually short in duration with mild symptoms, if there are any noticeable symptoms at all. You may even mistake it for the flu or common cold since many of the signs and symptoms are the same, such as a cough, low-grade fever and headache.

In Children

• The first noticeable symptom in children is usually a reddish rash that starts on the face and spreads to other parts of the body.
• Cold-like symptoms like cough, low-grade fever, congestion, and headache 
• Swollen lymph nodes
• A mild case of pink eye

In Adults

• Rash that starts on the face and spreads to other body parts
• Sore throat
• Low-grade fever
• Fatigue and general discomfort

The Dangers of Rubella and Pregnancy

Rubella can be very dangerous for unvaccinated people, especially pregnant women, as it can be harmful to the developing baby–either during pregnancy or after the baby is born. If contracted within the first 12 weeks of pregnancy, the risks of long-term complications to the baby are dramatically increased.

Some of the potential complications include:

• Premature birth, stillbirth or miscarriage
• Hearing problems, including deafness 
• Cataracts or blindness
• Heart problems, including congenital heart disease
• Low birth weight
• Intellectual disabilities, behavioral problems or microcephaly (a smaller head than usual)

Congenital Rubella Syndrome (CRS)

Many of the above complications are due to CRS, which is usually linked to maternal rubella infections during the first 12 weeks of pregnancy. CRS can cause severe congenital disabilities, which is why it’s critical to get vaccinated before conception and take precautions to avoid transmission. There isn’t a treatment for CRS, so unvaccinated pregnant women must take proper precautions to avoid transmission. 

Understanding Rubella Immune Status

Since most people receive the Measles, Mumps, and Rubella (MMR) as young children, it’s not uncommon to be unsure of your rubella immune status. This just means you have received at least one (1) dose of the MMR vaccine and are therefore protected from the virus. That doesn’t mean you can’t get rubella; it just means your immune system knows how to fight the virus. For confirmation, you can ask your parents or guardians, check medical records or take a rubella blood test. 

The Rubella Blood Test: How to Know Your Status

The rubella blood test checks for antibodies, called Rubella-virus specific IgG antibodies (rubella IgG, to determine if you’re immune to the virus. It’s usually done during a pre-pregnancy or early pregnancy check-up through a simple blood draw. If your test results come back with 1.0 or higher IgG, that means you have rubella antibodies and are immune to future infections.

Is the Rubella Vaccine for Pregnant Women Safe?

You should not get the MMR vaccine if you are pregnant or planning to become pregnant within the next four weeks. There isn’t clear evidence that the virus will harm the developing baby, but since it is a live virus vaccine (meaning you’d receive a small amount of the virus), experts recommend against the vaccine. 

The best way to protect yourself is to confirm your immune status before conception and get vaccinated if you are not. If you get vaccinated in preparation for pregnancy, you should not get pregnant the following four (4) weeks after the vaccination. You can also get vaccinated immediately after birth to protect future pregnancies.

Prevention and Next Steps for Expecting Mothers

If you’re pregnant and are unsure of your immune status, you will likely receive a rubella blood test. For unvaccinated pregnant women, you won’t be able to get vaccinated. However, there are some steps you can take to protect yourself and your baby. Such as:

• Avoid sick people, even if they appear to have a common cold, as many of the symptoms of rubella mirror other illnesses–like coughing and a low-grade fever
• If someone you know confirms that they have rubella, you should stay away from them for at least 7-10 days, especially if they are also unvaccinated.
• Frequently wash your hands with soap, and disinfectant commonly used surfaces with an antibacterial cleaning product.
• Wear a mask in heavily populated areas.

When to See the Doctor

Contact your healthcare provider immediately if you believe you’ve been exposed to rubella or start exhibiting signs of disease. If someone you know or have come into contact with confirms that they have rubella, your healthcare provider will test for early infection and susceptibility. They can advise you on the next steps based on your test results.

Thinking About Getting Pregnant? Schedule a Pre-Conception Appointment at Genesis

When it comes to rubella, the best defense is a good offense. If you are thinking of getting pregnant, request an appointment with a Genesis OBGYN for a preconception screening. During this appointment, we will review your medical records, including vaccinations, to ensure you’re prepared for pregnancy. The MMR vaccine is safe and effective; just one (1) dose is 97% effective against rubella infections. Take measures to protect yourself and your future children and confirm your immune status.