This pamphlet explains:

Types of childhood illnesses that can cause problems in pregnancy How to help prevent childhood illnesses What to do if you are exposed to an infection

Severe problems from childhood illnesses during pregnancy are rare. Most women already are immune to these diseases.

Childhood Illnesses During Pregnancy

Some illnesses are thought of as childhood problems, but adults also can get them. These illnesses, which are caused by viruses, include:

• Chickenpox
• Fifth disease
• Rubella
• Measles
• Mumps

People who have had these illnesses are immune to them and most likely will not get them again. This is because their bodies have made antibodies that protect against these diseases.

Other people are immune because they have had vaccines. Vaccines cause the body to make antibodies, which occurs in most cases without causing severe illness. Many people have had vaccines for rubella, measles, and mumps. Some also have had a vaccine for chickenpox.

Some people are not immune to childhood illnesses. These people have either not had the diseases and they have not had vaccines, or the effect of the vaccine has worn off. If you are pregnant and not immune to a childhood illness, try to stay away from people who have—or might have—the illness. These illnesses can cause problems for you and your baby. These problems include:

• Birth defects
• Miscarriage
• Stillbirth
• Anemia

If you are pregnant or thinking about having a baby, talk to your doctor about childhood illnesses. Tell him or her which vaccines you have had and when you had them. Also, tell your doctor if you have been around a person who has, or may have, a childhood illness.

If you are pregnant but have not had vaccines to protect against childhood illness, ask your doctor when you should get them. Some vaccines should not be given to pregnant women. If you may want to get pregnant again, plan to get vaccinated before you get pregnant. The vaccines presented in this pamphlet are safe for you and your baby while you are breastfeeding.

Types of Childhood Illnesses

Chickenpox

Chickenpox, or varicella, is one of the most common childhood illnesses. If you have had chickenpox, you are immune. Most adults are immune to chickenpox because they either have had the illness or the vaccine for it.

Childhood Illness Facts
Illness	Signs	When Signs Appear	When It Can Spread
Chickenpox (varicella)	Rash Fluid–filled, itchy blisters that dry and form scabs Fever Malaise	10–21 days after exposure	1–2 days before the rash appears and until all blisters have scabs (up to 5 days after the rash appears)
Fifth disease	Cold-like symptoms followed by rash on the cheeks, arms, legs, and trunk Sometimes joint pain and swelling	Usually 4–14 days after exposure, but sometimes as many as 20 days after exposure	Before the rash appears
Rubella (German measles)	Non–itchy rash Fever Swollen lymph glands Joint pain and swelling	2–3 weeks after exposure	10 days before to 10 days after the signs appear
Measles	Fever Runny nose and watery eyes Tiny white spots on lining of mouth Skin rash that begins on the forehead and spreads down the body to the feet	7–11 days after exposure	2 days before to about 4 days after the rash appears
Mumps	Fever Swollen glands under the jaw	12–25 days after exposure	3 days before to at least 10 days after the signs appear

This illness often begins with symptoms like those of the common cold. These symptoms are followed by fever and itchy, fluid-filled bumps on the skin. Adults who develop chickenpox can get sicker than children with the illness.

Chickenpox can be more severe if you are pregnant. For instance, pregnant women sometimes get pneumonia at the same time.

Chickenpox is very contagious (easy to catch). It is spread from one person to another even before the rash appears.

If you are pregnant and not sure if you have had chickenpox, you could be at risk. If you know someone who has been exposed or who has the illness, try to stay away from him or her. Chickenpox can be harmful to you and your baby.

Early in pregnancy, the chance of harm to your baby is low. If you get chickenpox a week or more before giving birth, the disease may be passed on to your baby. In most cases, this is not a serious problem. Your baby may be born with chickenpox, but will likely recover fully. Your antibodies are passed on to the baby. This helps protect the baby against severe illness.

If you get chickenpox less than a week before giving birth, there may not be enough time for antibodies to form. Your baby is more likely to get a severe case of chickenpox. In this case, your baby should be treated when he or she is born.

Tell your doctor right away if you think you have been exposed to chickenpox while you are pregnant. A routine blood test can confirm if you have antibodies and, thus, are not at risk.

If you have been exposed and do not have antibodies, you are at risk. Your doctor may give you a drug called varicella-zoster immune globulin (VZIG). This drug may prevent you from getting very ill from chickenpox. To work, it must be given within 3 days of when you were first exposed to the virus.

Women who are not immune to chickenpox, should plan to be vaccinated at least 1 month before becoming pregnant. The complete vaccine is given in two doses, one month apart. If you are pregnant now, talk with your doctor about when to get the vaccine. You should not have the chickenpox vaccine while you are pregnant.

Fifth Disease

Fifth disease is a common, mild illness that spreads easily to others. It is called fifth because it was the fifth disease found in a group of diseases that cause fever and skin rash in children. It is caused by a virus called parvovirus B19.

The main symptom of fifth disease is a rash. It often starts as a bright red rash on the cheeks and spreads to the arms, legs, and trunk of the body. In rare cases, people with fifth disease also have joint pain and swelling. Many people have no signs at all.

About one half of all adults are immune to fifth disease because they were exposed to it in the past. There is no vaccine for fifth disease. Adults who have close contact with children are more likely than others to get fifth disease.

If you have fifth disease while pregnant, you probably will have only mild illness. Your baby most likely will not have problems. There is a slight chance that fifth disease can cause the baby to have anemia, which can lead to miscarriage and stillbirth. This may require treatment. Your doctor may use ultrasound to monitor the fetus if you have fifth disease while pregnant.

Rubella, Measles, and Mumps

Most people are immune to rubella, measles, and mumps because they either have had the vaccine or had the diseases. Usually measles and mumps do not pose a major problem during pregnancy. However, rubella (German measles), can be harmful to pregnant women and their unborn babies.

Signs of rubella in the mother often are little more than a mild rash. In the fetus, rubella can cause problems such as heart defects and deafness. It also can cause stillbirth, miscarriage, and preterm birth.

Vaccines and Pregnancy Many vaccines should not be given during pregnancy. If you are not immune to childhood illnesses, try to get vaccinated before you become pregnant. Complete the vaccine for chickenpox (2 doses) at least 1 month before pregnancy. Get vaccines for rubella (German measles), measles, and mumps at least 1 month before pregnancy. If you are pregnant now, plan to get the vaccines before you become pregnant again.

About one half of babies whose mothers have rubella in the first month of pregnancy have problems. The chance of problems is lower if a woman has rubella later in pregnancy.

Women who are not immune to rubella, measles, or mumps, should plan to get vaccines before they become pregnant. If you are pregnant now, your doctor will do a test to see if you are immune to rubella. The effects of the vaccines may wear off, so you may need to get them again.

You should not have rubella, measles, and mumps vaccines if you are pregnant. You should be vaccinated soon after giving birth, though. It is best to wait at least 1 month after getting the vaccines before trying to become pregnant.

What You Can Do

Most adults are immune to childhood illnesses because of vaccines or past exposure. Your doctor can test to see if you are immune.

If you are not immune, take steps to protect your baby and yourself:

• Get needed vaccines before you become pregnant.
• Avoid close contact with people who have, or may have, childhood illnesses.

Protect others as well. If you think you have been exposed to an illness and could be contagious, try not to infect others. Call your doctor if you have concerns.

Finally...

Severe problems from childhood illnesses during pregnancy are rare. Most women already are immune to these diseases. If you are not immune and think you have been exposed to a childhood illness, talk to your doctor right away. He or she may suggest treatment to help prevent problems for you and your baby. He or she also may want to watch for problems that could be caused by the illness.

Glossary

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Antibodies: Proteins in the blood that are produced in reaction to foreign substances, antigens.

Miscarriage: The spontaneous loss of a pregnancy before the fetus can survive outside the uterus.

Preterm: Born before 37 weeks of pregnancy.

Stillbirth: Delivery of a baby that shows no sign of life.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © December 2002 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

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