Measles in pregnancy poses serious maternal and fetal risks
Pregnant people with measles are at higher risk of pneumonia, hepatitis, and hospitalization and have a 10-fold higher risk of death than those who are not pregnant.1 Infection also increases the risk of miscarriage, intrauterine growth restriction, and premature birth.2
Intravenous immunoglobulin (IVIG) can reduce the risk of infection or lessen the severity of measles among exposed, susceptible pregnant people
One dose of IVIG (400 mg/kg) is recommended up to 6 days after exposure. 3 Susceptible pregnant contacts include those who have not had previous measles infection and have not received any measles-containing vaccines. People who have had only 1 previous dose of measles vaccine or whose vaccination status is unknown may also be susceptible, and if their immunoglobulin G testing returns a negative result or is not readily available, they should also receive IVIG.3 Preterm labour should be considered a potential sign of infection in exposed, susceptible pregnant individuals.
Special care considerations are necessary for pregnant people admitted to hospital with measles, given its airborne transmission and high infectivity
Infectious disease specialists should be consulted when a pregnant patient has measles. Where concern for maternal complications exists, patients should be admitted to a hospital with an appropriate level of maternal and neonatal care.4 Strict infection control measures are required during their infectious period and for neonates with exposure or infection. The duration of isolation should be determined in consultation with the infection prevention and control team.
Maternal infection in the 2 weeks before delivery can lead to severe congenital infection
Congenital measles infection usually manifests within the first 10 days of life and can present with fever, rash, hepatitis, and pneumonia. Infection can have serious acute and long-term complications, including subacute sclerosing panencephalitis and death.5 When given to the neonate at birth, immunoglobulin may prevent infection or decrease complications from measles.6
Ensuring all individuals of reproductive age are up to date with their measles vaccinations is crucial to prevent complications in pregnant people and neonates
Vaccination status for measles should be reviewed in this population and vaccination provided for susceptible nonpregnant people who are eligible.7
See related editorial at www.cmaj.ca/lookup/doi/10.1503/cmaj.250820
Footnotes
Competing interests: Jennifer Hutson reports funding from the Academic Medical Organization of Southwestern Ontario. No other competing interests were declared.
This article has been peer reviewed.
References
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