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Infections

Dealing with Infections during pregnancy

Fifth’s Disease/ParvoB19
Genital Herpes
GBS
Hand Foot Mouth Disease

Fifth’s Disease / ParvoB19 in Pregnancy

Fifth’s disease is a common childhood virus. Pregnant women are frequently exposed to through contact with children. ParvoB19 infection can cause a viral-cold-like illness in adults, but more often there are NO symptoms.

The virus, after infecting the pregnant mother, may cross the placenta into the fetus, and infect the fetal blood cells. A severe infection of the fetus may cause a low blood count (anemia) in the unborn baby. This is a well recognized, but RARE complication of pregnancy.

There is a blood test to determine maternal immunity. If not immune, then a second blood test, done two weeks later, can detect recent infections. Only those women with blood test proven recent infection need fetal testing. Fetal testing is started one month later. Frequent ultrasound measurements are usually enough to prove a normal fetal blood count. No additional testing or treatment is needed in babies with a normal blood count.

In order for ParvoB19 to matter to a baby:

  • first the mother should be exposed
  • and she must not be immune
  • then she needs to show blood test proof of infection
  • then the baby actually has to be infected
  • and then the baby’s infection has to be serious enough to cause an anemia.

And the chance of ALL those things happening is RARE.

Genital Herpes in Pregnancy

Herpes is a sexually transmitted infection. You do not need to have sex to get it. Skin to skin contact “down there” is enough to pass it from one to another. Condoms do not fully prevent getting or passing on a herpes infection. Herpes is a virus. Once you get herpes it never really goes away. Herpes infection causes outbreaks, in the form of a really painful sore or blister. Many patients get a warning, like itching, before the sore appears. The warning sign is called prodrome. Herpes is most contagious during the prodrome AND while the sore is visible.

Herpes can be passed from mom to baby during vaginal delivery. Baby infection is RARE, but more common when vaginal delivery happens during an outbreak OR when she feels the prodrome. The HIGHEST risk of baby infection is having a vaginal delivery during a first-time outbreak. Women who already have genital herpes when they get pregnant have a LOW chance of passing it to the baby, even during an outbreak. Cesarean section is the recommended delivery during a herpes outbreak AND during prodrome. For patients who have ever had genital herpes, a thorough examination of the cervix, vagina and vulva is indicated, when they are admitted in labor.

Herpes medicine can reduce the chance of an outbreak. It is recommended that women begin herpes medicine, daily, after 35 weeks. Women who have already had two or more outbreaks during pregnancy may consider daily herpes medicine for the remainder of pregnancy. The medications (available in the USA) for treating herpes outbreaks are Zovirax and Valtrex. Neither medicine works better than the other, as long as a patient TAKES the medication.

Dosage for preventing herpes outbreaks: take EVERY DAY.

  • Acyclovir 400 mg TWICE daily
  • Valtrex 500 mg ONCE daily.

GBS in Pregnancy

GBS (Group B streptococcus) is a type of bacterial infection that can affect up to 25% of healthy women. GBS lives in the large intestines, and can found on the skin between the vagina and rectum. The bacterial infection makes approximately 1/2000 babies sick and the infection can be devastating. Since 1996 there has been a national effort to prevent this infection. Exposure to the baby happens after the water-bag is broken and during labor and delivery. Giving laboring mothers intravenous antibiotics reduces the chance a baby will become infected with GBS bacteria. Giving antibiotics before labor does not totally prevent baby from becoming infected however. We don’t give antibiotics to all mothers, only those who have tested positive for GBS on them.

Since the bacteria is not visible, we must test for it. And because the bacteria comes and goes on its own, we need to test pregnant mothers close to the due date. The optimal time to test is one month prior to the due date. The CDC recommendations suggest intravenous penicillin during labor. The rest of labor and delivery is the same.

Here are the CDC and government web sites with the full story on GBS: CDC GBS home – http://www.cdc.gov/groupbstrep/about/newborns-pregnant.html and MMWR, full details, GBS – http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

Hand Foot Mouth Disease in Pregnancy

I have been unable to find any published reports of Hand Foot Mouth Disease causing harm to moms or babies during pregnancy. Because enteroviruses, including those causing hand-foot-mouth disease are common, pregnant women are frequently exposed, especially during summer and fall months. The risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children – the primary spreaders of enteroviruses.

Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes pregnancy complications, such as miscarriage, stillbirth or birth defects. Mothers infected shortly before delivery may pass the virus to the newborn.

The above information is an excerpt from the CDC web site. You can read the full information at: http://www.cdc.gov/hand-foot-mouth/index.html and http://www.cdc.gov/non-polio-enterovirus/pregnancy.html