Infections and diseases during pregnancy
Even though most pregnancies fortunately proceed without abnormalities, there are some diseases that can be dangerous for mother and child. How can you protect yourself and your baby? How can you prevent an illness and what treatment options are there?
Get informed!
Infection and course
Ringworm (erythema infectiosum) is an infectious disease caused by the parvovirus B19. It is usually transmitted by droplet infection from person to person (e.g. by sneezing or coughing). The majority of infections occur in children and adolescents between the ages of 5 and 15. However, it is not uncommon for adults to be infected as well. It generally takes 4-20 days from the time of infection until the onset of the disease.
The disease often begins with a mild fever, headache and an itchy rash on the cheeks that eventually spreads over the whole body and persists for about a week. About 10% of children and 80% of adults develop joint symptoms, which can sometimes last for months or even years.
Special features during pregnancy
During pregnancy, the virus can be transmitted to the unborn child via the placenta. Here it attacks the cells responsible for blood formation. Severe anaemia, hydrops fetalis(accumulation of water in the foetal tissue) and even death of the foetus can be the result.
The majority (approx. 60 %) of infections run their course without the mother showing any signs of illness!
How is the diagnosis made?
Ringworm is often confused with rubella, measles or an allergy. A reliable diagnosis can only be made by a blood test (serology). In case of suspected infection or contact with a sick child, a serological examination should be carried out immediately to know the initial situation.
If an infection has already been passed through previously, there is immune protection so that the unborn child cannot fall ill. If there is no immunity, a new blood test is required after two weeks to be able to exclude a possible infection.
Therapy of ringworm
There is no special therapy or prophylaxis. If there is a first infection during pregnancy, close monitoring must be carried out in any case to exclude a severe infection of the child. This includes ultrasound checks and further blood tests every 1-2 weeks over a period of at least 6-8 weeks. If hydrops fetalis occurs, a child blood exchange can be performed in specialised clinics.
Prevention against ringworm
Avoid contact with children who have ringworm during pregnancy. However, a ringworm infection in a person with whom you have contact can often not be detected immediately. You can find out whether you have immune protection due to a previous infection and whether your child is therefore protected by having a blood test for ringworm.
However, the costs for testing a possibly existing immune protection are not covered by the statutory health insurance funds. They only cover the costs if you have had contact with a child or adult with ringworm or if you yourself show signs of the disease.
Rubella is a typical, mostly harmless childhood disease caused by rubella viruses. Infection occurs via droplet infection, the incubation period is 14 -21 days. Usually there is a bright red, small-spotted skin rash, rarely also fever and swelling of the lymph nodes. The general condition is often only slightly affected, so that an infection can also pass completely unnoticed.
Rubella is highly contagious. About one week before to one week after the development of the rash, a sick person is infectious.
Rubella test
A blood test and the determination of the rubella titer can show whether there is sufficient immunity against infection with the rubella virus. If the titer is less than 1:16, it can be assumed that the pregnant woman would contract the disease from someone with rubella. She should therefore avoid being in the vicinity of someone who has (also potentially) contracted rubella until the end of the pregnancy.
The rubella test is one of the routine laboratory examinations as part of maternity care.
Rubella in pregnancy
Rubella is one of the most feared infections during pregnancy. An illness can lead to severe damage to the unborn child. The earlier an infection occurs during pregnancy, the more serious the consequences.
Infection with the rubella virus before the 17th week of pregnancy leads in 30% of all cases to rubella embryopathy (Gregg syndrome) with heart defects, eye and ear damage, considerable mental and motor disability and short stature. An infection from the 17th week of pregnancy remains without consequences for the child in 95% of cases.
If a pregnant woman without immune protection has possibly contracted rubella, administration of immunoglobulins (antibodies) until the 8th day after contact with the virus can reduce the risk of contracting the disease.
Immunity and vaccination
An infection with the rubella virus leaves a lifelong immunity. Protective vaccination is possible and is usually carried out with a combined vaccine against measles, mumps and rubella. Rubella vaccination is recommended by the Permanent Vaccination Commission of the Robert Koch Institute (STIKO) for all children from the age of 12 months and for all non-immune women of childbearing age.
About 5 to 10 % of all expectant mothers develop diabetes during pregnancy, the so-called gestational diabetes. Gestational diabetes is a temporary form of diabetes that only occurs during pregnancy and disappears after delivery. This disorder of the carbohydrate metabolism can occur when insufficient insulin production can no longer compensate for the hormonally induced increase in the blood sugar level.
Risk factors
- Age of mother over 30
- Overweight
- Family history
- Previous birth of a child over 4,500g
- Previous miscarriage or stillbirth
- Sugar metabolism disorder in previous pregnancies
- High blood pressure
Prevention
The following factors have a preventive effect against gestational diabetes:
- Physical activity / sport
- Low sugar diet
- Avoiding sweet, sugary drinks
- Eat more vegetables than fruit in a healthy diet
Consequences for mother and child
High blood sugar levels can be dangerous for mother and child.
The following complications may occur in pregnant women:
- Increased incidence of urinary tract infections
- Pregnancy-related high blood pressure
- increased amniotic fluid
- premature contractions
- Delivery by caesarean section is more common
- Tendency to have miscarriages or stillbirths
The following dangers exist for the unborn child:
- increased insulin production
- Increased growth (too big and too heavy)
- Immaturity (especially of the lungs)
- Neonatal jaundice
- More frequent premature births
- Hypoglycaemia after birth
- Respiratory distress syndrome
Symptoms and diagnosis
Since gestational diabetes does not usually cause any symptoms, it often goes undetected. It is assumed that about 50% of diabetes cases are overlooked. Suspicions of gestational diabetes can arise from a woman's own or family history, a previous birth of very heavy children, urine tests (excretion of sugar) and ultrasound examinations.
An oral glucose tolerance test can be used to reliably diagnose gestational diabetes.
Treatment of gestational diabetes
If gestational diabetes is diagnosed, we refer the expectant mother to a diabetologist for co-treatment. In the case of a slight increase in blood sugar, a change in diet is generally sufficient. In some cases, insulin therapy is necessary. Consistent treatment of the elevated blood sugar levels is absolutely necessary. If it is possible to keep the blood sugar levels within the normal range, all complications can be avoided.
Group B streptococci are found in the genital area in about 10-15% of all women. These bacteria are normally harmless colonisers of the vaginal mucosa and do not cause any symptoms. Pregnant women can, however, infect the newborn with B-streptococci during birth.
As a result, severe infections can occur in the child shortly after birth ("early onset") or after 1 - 6 weeks ("late onset"). The early infection is associated with blood poisoning (sepsis), pneumonia and meningitis. Neurological damage and long-term consequences are also to be expected in this early form. In the late form, the risk of dying from such an infection can be very high, especially in premature babies.
Prevention against B-streptococcal infection
Treating the mother with antibiotics during birth can significantly reduce the risk of infection for the child.
Such preventive treatment is useful in the following cases:
- If at a previous birth the child had a B streptococcal infection,
- if the expectant mother has already been diagnosed with a urinary tract infection with B streptococci,
- if a vaginal smear has revealed a colonisation with B-streptococci.
It is not advisable to take antibiotics for a long time before the birth, as the B streptococci reappear relatively quickly after the end of the therapy. Tell the clinic or your midwife if you have been diagnosed with B streptococci.
Toxoplasmosis is a common, mostly harmless infectious disease. In almost every second adult, antibodies can be detected as a sign of a previous infection.
The causative agent of a toxoplasmosis infection is a single-celled parasite(Toxoplasma gondii). The main host of this parasite is the cat. The eggs of the toxoplasmosis pathogen are excreted in the faeces of infected cats and spread in the environment by wind or dust. In this way, they can be ingested by humans, but also by slaughtered animals. If the latter is the case, the following happens: So-called toxoplasmosis cysts form in the muscle tissue of the infected animal. If the infected meat is consumed raw by humans (e.g. as mince or tartar), there is a risk of infection. As soon as the infection has occurred, the immune system forms antibodies against the foreign invader "toxoplasma".
Infection routes
- Ingestion of toxoplasmosis eggs from cat faeces (e.g. when eating unwashed lettuce, through gardening or contact with an infected cat).
- Ingestion of toxoplasmosis cysts when eating meat containing cysts from infected slaughtered animals that is still raw or has not been sufficiently cooked or fried (e.g. minced meat, tartare, steak).
Symptoms
There are no typical symptoms that immediately suggest toxoplasmosis. In many cases, a toxoplasmosis infection goes completely unnoticed. In other cases, there are flu-like symptoms and swelling of the lymph nodes. The only diagnostic possibility is the determination of antibodies in the blood.
Toxoplasmosis in pregnancy
For non-pregnant women, toxoplasmosis is generally a harmless disease that heals without further consequences. After a toxoplasmosis infection, there is permanent immunity. An infection of the child in the womb can then no longer occur.
However, a first infection with toxoplasma during pregnancy is more risky. In this case, the disease can be transmitted to the unborn child. There is a risk of miscarriage or severe damage, especially to the child's brain. Therefore, the first toxoplasmosis infection during pregnancy is a serious problem.
Diagnosis of toxoplasmosis
In the case of toxoplasmosis infection, early diagnosis is decisive for the success of the therapy! A diagnosis can only be made by means of a blood test, which, however, is not part of maternity care. It is therefore only paid for by the statutory health insurance funds if there is a concretely justified suspicion of infection.
Treatment of toxoplasmosis
Toxoplasmosis is a striking example of how important prenatal examinations are for the well-being of the child. Thanks to medical research, it is now possible to cure toxoplasmosis: If a blood test reveals a suspicion of a fresh toxoplasmosis infection, treatment with an antibiotic is initiated immediately. This is a great advance, because in earlier times it was not uncommon for a pregnancy to be terminated because of an acute infection.
Prevention against toxoplasmosis infection
If you have not yet had a toxoplasmosis infection and do not have antibody protection, we strongly advise you:
- Eat only well-cooked or roasted meat and sausages.
- Wash vegetables, lettuce and fruit very thoroughly before eating.
- Wash your hands with soap - especially after gardening, before and after kitchen work, before eating.
- If you are pregnant and keep a cat, pay attention to the following advice: Use canned and dry food, keep your cat indoors only and have someone else clean the poop box with hot water daily.
- In addition, the toxoplasmosis antibodies should be checked regularly in the further course of the pregnancy.
Infection and course
Chickenpox (varicella) is a widespread infectious disease caused by the varicella zoster virus. It occurs mainly in children and is accompanied by a vesicular rash.
Chickenpox is transmitted from person to person. This happens through droplet infection, i.e. via nasal and throat secretions (e.g. through sneezing or coughing), and less frequently via the stool and urine of infected persons.
It generally takes 10 - 21 days from the time of infection to the outbreak of the disease. Typical signs of the disease are an early onset of fever, a rash with pustules and vesicles, and a moderate impairment of the general condition.
In most cases, the rash becomes visible about 24 hours after the onset of fever. It starts on the face, scalp or shoulders with numerous red, widely scattered pustules that gradually spread over the whole body. After 2 - 3 weeks, the rash disappears again.
Special features during pregnancy
Most pregnant women are protected by a previous infection, often contracted in childhood. However, one in 20 women has no immunity and can become infected with chickenpox in the course of pregnancy from a child who has the disease or from an adult who has shingles.
Infection in the first 6 months of pregnancy
If the mother is infected, the unborn child rarely falls ill. In the case of an infection, however, the consequences are severe. There is a skin infection with scarring, underdeveloped arms and legs, low birth weight, damage to the eye and brain and a high mortality rate.
Infection around the time of birth
The risk of contracting the disease is particularly high for the child around the time of birth. For about one third of the children, the infection takes a fatal course. If the mother falls ill earlier than 4 days before delivery, the child receives maternal antibodies that protect it from the infection or significantly weaken the sale of the disease. If the disease occurs between the 4th day and the 2nd day after delivery, such protection is no longer guaranteed and the child becomes severely infected.
Determination of immune protection
After a chickenpox infection, there is permanent immunity and the child cannot be infected. Therefore, only the initial infection can be dangerous for the unborn child. This means that you should first clarify whether you have already had a chickenpox infection and are therefore protected.
If this is not certain, a varicella serology can be carried out, but the costs are not covered by the statutory health insurance funds. They only bear the costs if there was actual contact with the infected person.
What to do if there is no immune protection?
If you do not have immunity to chickenpox, be sure to observe the following precautions:
- Avoid contact with children who have chickenpox and with shingles patients.
- Should you nevertheless have contact with a sick person, please contact us immediately and discuss the further procedure with us. We will then initiate appropriate preventive treatment as soon as possible.
Vaccination against varicella has also been possible for a short time, but may only be given to non-pregnant women.
The cytomegalovirus (CMV) can be transmitted through contact with body fluids or through contact with mucous membranes as well as through blood and blood products. The initial infection usually runs without symptoms or only with mild and uncharacteristic symptoms (fever, swelling of the lymph nodes). Rarely, jaundice or myocarditis may occur. Severe courses of infection are mainly observed only in immunocompromised patients (e.g. cancer or AIDS patients).
Cytomegalovirus infection during pregnancy
During pregnancy, the virus can be transmitted to the child via the placenta or at birth via the birth canal. The children of mothers who experience a first infection in early pregnancy are particularly at risk.
About 13% of these children infected in the womb have clinical abnormalities at birth, e.g. low birth weight, bleeding into the skin, jaundice, enlarged liver and spleen. In addition, serious and mostly permanent damage can occur, such as microcephaly (too small a head), calcifications in the brain, delayed mental and physical development, hearing loss and damage to the eyes.
Diagnosis of cytomegalovirus infection
A reliable diagnosis is only possible by determining the CMV antibodies in the blood. The blood test canalso determine whether the patient is immune due to a cytomegalovirus infection she has already had or whether she is at risk due to a first infection.
In the absence of immunity, regular check-ups should be carried out in order to be able to diagnose a new infection in good time. However, the costs for this are not covered by the statutory health insurance funds. They only bear the costs if you have had contact with someone who has the disease or if you yourself show signs of the disease.
If a fresh infection is detected during pregnancy, the amniotic fluid will be tested to see if the child has been infected. We will decide all subsequent measures with you.
Therapy
There is no effective therapy so far.
Prevention
There is no vaccination against cytomegaly.
The virus is infectious on saliva- and urine-contaminated objects for up to 48 hours, but can be inactivated by soap. Pregnant women can therefore reduce the risk of infection through simple hygiene measures: It is important to wash hands carefully with soap after any kind of contact with bodily excretions of young children (changing nappies, feeding, blowing nose, wiping tears and saliva, touching toys that have been salivated on, etc.).
Also, do not kiss young children on the mouth, do not eat their leftovers and do not share eating and drinking vessels, cutlery, toothbrushes, flannels or towels with them.
Whooping cough (pertussis) is caused by bacteria. The pathogen is widespread worldwide and can also be passed on by people who contract it unnoticed. Harmless to severe courses of the disease are possible at any age. For babies, whooping cough can even be life-threatening. One third to about half of all infants who fall ill contract the disease from their own parents.
Vaccination is the best way to protect yourself against whooping cough. It reduces the risk of falling ill or suffering severe complications. If the mother was vaccinated during pregnancy, the newborn baby receives nest protection against whooping cough until it can be vaccinated itself. This is only possible from the age of two months and only after at least two doses of vaccine is sufficient protection established in the majority of babies.
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