Rubella (German Measles) During Pregnancy

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KEY POINTS

• Rubella is a viral infection that usually causes a mild illness with rash. If you are infected with rubella during the first 3 months of pregnancy, you may have a miscarriage or stillbirth, or your child may be born with serious birth defects.
• You may not need treatment for rubella unless you are pregnant. If you are less than 20 weeks pregnant and have rubella or are exposed to rubella, you may be given medicine called hyperimmune globulin.
• Check with your healthcare provider to make sure you are protected before you get pregnant.

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What is rubella?

Rubella is a viral infection that usually causes a mild illness with rash.

If you are infected with rubella during the first 3 months of pregnancy, you may have a miscarriage or stillbirth, or your child may be born with serious birth defects, such as heart defects, hearing loss, cataracts, spleen and liver damage, bone disease, or problems with learning, growth, or behavior. Birth defects are rare if you have rubella after the 20th week of pregnancy.

Rubella used to be a common childhood disease. In the US, most children now get shots of rubella vaccine to prevent the disease, so the disease is much less common. Rubella occurs worldwide, and the risk of being exposed to rubella outside the US can be high in places where many people may not be vaccinated against rubella.

The rubella virus is spread through the air from an infected person’s cough or sneeze. If you are exposed, the virus can infect the baby through the placenta.

Rubella is contagious for about a week before you start having a rash and then stays contagious for 5 to 7 more days. Rubella is also called German measles.

What is the cause?

The rubella virus is spread through the air by coughing or sneezing.

What are the symptoms?

You may not have any symptoms. If you do, they usually appear about 2 to 3 weeks after exposure to the virus. Symptoms may include:

• A rash that starts on the chest or face, spreads to other parts of the body
• Mild fever
• Runny nose and cough
• Red, watery eyes
• Headache and joint aches
• Feeling tired
• Tender, swollen glands on the neck and below the ears

Symptoms and problems for babies infected with rubella during pregnancy may include:

• Miscarriage
• Stillbirth
• Hearing loss
• Eye problems (cataracts)
• Heart defects
• A small brain or swelling of the brain
• Spleen and liver damage
• Bone disease
• Problems with learning, growth, and behavior

Some of these problems may not appear until later in a child's life.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have a blood test.

After your baby is born, your healthcare provider will look for eye, heart, and other problems in the newborn. Samples of fluid from the baby's nose and throat and of the baby's bowel movements and blood may be tested. Other tests may also be done.

How is it treated?

Since the symptoms are so mild, treatment is not usually needed unless you are pregnant. If you are less than 20 weeks pregnant and have rubella, or you have not been vaccinated against rubella and have been exposed to rubella, you may be given medicine called hyperimmune globulin. This medicine may reduce your symptoms, but your baby may still have health problems caused by rubella. Talk to your healthcare provider about your choices for treatment.

There is no specific treatment for newborns infected with rubella.

How can I take care of myself?

Follow your healthcare provider's instructions. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent rubella?

If you had rubella earlier in life or have had shots against rubella, you are protected. (Rubella vaccine is included in the MMR shot. This is for measles, mumps, and rubella and is recommended for all children at 12-15 months and again at 4-6 years of age.)

Check with your healthcare provider to make sure you are protected before you get pregnant. Blood tests can be done to see if you are immune to rubella. If you are not immune and not pregnant, you can have a rubella shot to protect you and any children you might have in the future. To be safe, you should avoid getting pregnant for 1 month after the shot. However, there has never been a reported complication of pregnancy for mothers who get pregnant sooner than this after the shot.

If you are pregnant, you may be tested for immunity at your first prenatal visit with your healthcare provider. If you are immune to rubella, there is no danger of infection. If you are not immune to rubella, you cannot get the shot until after your child is born. It is safe to get the shot while you are breast-feeding your child.

Call your local health department or healthcare provider for more information about shots.