Exposure to illness in pregnancy

Hand, foot and mouth disease

Hand, foot and mouth disease is a common viral infection that typically affects children under the age of 10 years.

  • Caused by a virus (usually coxsackie virus A16) and is not related to foot and mouth disease in animals.
  • Symptoms:
    • Generally mild, often beginning with a rash of small red dots, which later become blisters or sometimes ulcers. They appear inside the mouth, on the sides of the tongue, on the palms of the hands and the soles of the feet.
    • The blisters usually last for 7–10 days, and may be accompanied by a high temperature (fever), irritability and sore throat.
  • More common during warmer weather.
  • Spreads easily, usually by direct contact with the blisters, faecal contamination (for example, changing nappies) or via respiratory secretions such as coughing, sneezing or touching something that has been coughed or sneezed on.
  • Does not appear to pose any risk to unborn babies.
  • The best way to avoid hand, foot and mouth disease is with good personal hygiene and hand washing. Teaching your children good hand washing techniques is also important. You should also:
    • Wash hands carefully after contact with the blister-like lesions, after touching nose and throat discharges and after contact with faeces
    • Let blisters dry naturally. Do not pierce the blisters, as the fluid inside is infectious and can be easily transferred to other people.
  • There is no specific treatment for hand, foot and mouth disease , but paracetamol can be used for pain or fever.

Slapped cheek (parvovirus)

Slapped cheek (paravirus) is a common virus in children aged 4–10 years, but can occur at any age.

  • Caused by human parvovirus B19, an airborne virus contracted from an infected person’s respiratory secretions, for example through coughing, sneezing or touching something that has been coughed or sneezed on.
  • Symptoms:
    • Some cases cause no symptoms at all, but in children there is usually a strong redness of the cheeks (hence the name ‘slapped cheek’). The rash may fade within a week but can reoccur over several weeks. It may also look worse after exposure to sunlight or on very hot days.
    • Usually little or no fever in children, but adults with slapped cheek may have additional cold-like symptoms and aching or swollen joints.
  • People with slapped cheek are infectious for one to two weeks before the onset of the rash, but not once the rash has developed.
  • The risk to your unborn baby is low.
  • Infection does not cause congenital abnormalities.
  • Approximately half of all women are immune to the virus by the time they reach childbearing age, but spread from mother to baby can occur in non-immune mothers.
  • Rarely, infection during the first 20 weeks of pregnancy can cause a type of anaemia (low blood count) in the baby. This usually resolves on its own but in some cases treatment may be needed.
  • The best way to avoid the virus is with good personal hygiene and hand washing.
  • If you feel you may have been exposed to parvovirus during your pregnancy you can be tested for immunity to the virus.
  • If you do develop the infection while pregnant, ultrasound may be performed every one to two weeks to monitor the health of your baby.

 

Chickenpox (varicella zoster virus)

If you’re pregnant and develop chickenpox you and your baby may face serious health risks.

  • Highly contagious viral disease caused by the varicella zoster virus.
  • Symptoms:
    • Main symptom is a blistering, extremely itchy skin rash. Other symptoms may include a high temperature, general feeling of being unwell and a runny nose.
    • Blisters tend to form on the abdomen, chest and back first, and progress to include the limbs and head. The blisters usually burst and develop crusts after several days. Ulcers may also develop.
  • Spread by airborne respiratory secretions (for example, coughing or sneezing) as well as by direct contact with the blisters.
  • An infected person is contagious for one to two days before the rash appears and remains contagious until all the blisters have formed crusts.
  • Many women are immune to the chickenpox virus, either because they had the infection as a child or have been immunised against it. However, if you are pregnant and develop chickenpox for the first time, you can become seriously ill.
  • Chickenpox in a pregnant woman can lead to pneumonia, hepatitis and encephalitis (infection of the brain).
  • Infection during the first trimester of pregnancy is associated with a small risk of miscarriage. If a woman is infected during the first 20 weeks of pregnancy there is also a risk of ‘foetal varicella syndrome’, which may cause growth retardation, skin scarring and neurological problems in the baby.
  • Risks to the baby are lower after 20 weeks of pregnancy. If a woman is infected from 20–36 weeks of pregnancy there is a small risk the baby will develop shingles* (herpes zoster) after they are born. If a woman is infected in the final four weeks of pregnancy the baby may be born with chickenpox. Maternal chickenpox during the last trimester may also lead to premature labour.
  • Pregnant women should avoid contact with people with chickenpox. If you have been exposed to someone with chickenpox you should call your obstetrician’s office immediately. You can have a blood test to see if you are immune to the infection.
  • An injection called varicella zoster immunoglobulin (VZIG), given within 72 hours of exposure to the disease, has been shown to prevent or reduce the severity of chicken pox.
  • If you develop chickenpox during your pregnancy, early medical review within 24 hours of the rash onset is important so that treatment options can be discussed.
  • A vaccine is now available for women planning a pregnancy who have not had chickenpox before. The vaccine involves two injections given one to two months apart. You should not become pregnant until one month after you have received the second dose of the vaccine.

*A note about shingles: Shingles occurs in people who have previously had chickenpox. If you develop shingles during pregnancy this does not appear to cause complications for your unborn baby.

Whooping cough (pertussis)

Whooping cough is a highly contagious infection that can be life-threatening to babies. It is caused by the bacteria Bordetella pertussis.

  • Symptoms:
    • Exposure to whooping cough may be difficult to determine as the infection typically begins like a cold, with a blocked or runny nose, mild fever and cough.
    • Babies usually don’t present with the cough but have difficulty breathing and feeding, can turn blue, choke and even stop breathing. They may develop pneumonia, feeding problems or seizures. Some babies die from the infection.
  • Whooping cough is easily spread by respiratory droplets (e.g. from coughing and sneezing). A person with whooping cough is infectious for up to three weeks after they start coughing.
  • If you are planning to become pregnant it is important to have the whooping cough vaccination prior to pregnancy.
  • If you are pregnant and have not been immunised, it may be possible to have the vaccination during the third trimester of pregnancy. If this is not possible you should have the vaccination as soon a possible after the birth of your baby.
  • Babies are at risk from birth and should be vaccinated according to the National Immunisation Program schedule. This begins at 6 weeks of age.
  • It is important that people who care for babies and children (e.g. parents and grandparents, childcare workers) also have a whooping cough vaccination so that they do not to pass on the infection to young children who are not fully immune.
  • If someone close to you has been diagnosed with whooping cough you should avoid contact until they are no longer contagious.
  • Immunity to the whooping cough virus decreases with time so it’s important that you and your child have all the recommended booster vaccinations. If you are unsure about the status of vaccinations for you and your family, check your blue book, or call the Australian Childhood Immunisation Register on 1800 653 809.

If you have any questions or concerns about exposure to these or other illnesses during pregnancy, please do not hesitate to contact Dr van der Griend’s office.

You can also ring MotherSafe on 9382 6539 (Sydney metropolitan area) or 1800 647 848 (non-Metropolitan area).