Rubella In Pregnancy: Causes, Symptoms, Diagnosis & Treatment
shreeja pillai 
Rubella or German measles is an infection caused by rubella virus that affects the skin and lymph nodes (1). It results in a skin rash and mild fever. However, in pregnant women, it could be serious as the virus can be passed to the fetus through the bloodstream.
Momjunction tells you how rubella is caused, the complications associated with it and what you can do to prevent viral infection. First, let’s know why rubella is dangerous during pregnancy.
What Are The Complications Of Rubella During Pregnancy?
Rubella can complicate your pregnancy if you get infected with it in the first 20 weeks. It can lead to (2):
- A miscarriage.
- A stillbirth, where the baby dies after 20 weeks.
- A premature birth, wherein the childbirth happens before 37 weeks of pregnancy.
- Congenital rubella syndrome (CRS), as the virus is passed on to the baby. CRS can result in vision, heart, hearing, growth, and bone development problems, intellectual disability, and spleen and liver damage in the newborn.
The risk of developing CRS in babies is higher if the mother contracts rubella in the first 12 weeks, and is lower after 20 weeks.
[ Read: Infections To Be Aware Of During Pregnancy ]
What Are The Chances Of The Fetus Getting Infected With Rubella?
The earlier you get infected by rubella during pregnancy, the higher are the chances of your baby contracting it (3) (4) (5).
If you get rubella early during pregnancy, there is a 90% chance of the fetus resulting in death or CRS.
- If you get rubella during the first 12 weeks of pregnancy, then there is an 85% chance of passing it on to your unborn baby, leading to CRS.
- If you get infected between 13 and 20 weeks of pregnancy, the chances of passing CRS are fewer.
- If you contract it after 20 weeks, then there may not be any problem to the fetus.
Rubella cannot be taken lightly during pregnancy. Hence, let’s understand its causes, and identify the symptoms.
How Is Rubella Caused?
Rubella is a contagious infection that spreads through the air when an infected person coughs or sneezes. The droplets from the infected person enter your body through your nose or mouth and spread the infection.
During pregnancy, you might be more vulnerable than during normal times, as your immunity system weakens. Hence, keep an eye on the symptoms if anybody around you is infected with rubella.
What Are The Symptoms Of Rubella?
Rubella could be asymptomatic in some cases. However, it is also associated with mild flu-like symptoms and rashes that disappear within seven to ten days. The flu-like symptoms include (5):
- A slightly high temperature (up to 102 °F) that remains high for several days
- Runny or stuffy nose, sore throat, and cough
- Swelling, inflammation or redness in the eyes, and watery eyes
- Swelling and pain in the lymph nodes that can last for more than one week, even after the rashes disappear
- Pink or reddish rashes that first appear on the face and gradually spread all over the body. These rashes last for three days
- Muscle or joint pain
In rare cases, the virus can lead to an ear infection or a swelling in the brain. It is of serious concern and its probable symptoms include:
- Continuous pain in the head that can get worse with time
- A persistent ear pain, which causes hearing difficulty
- Stiffness in the neck
If you contact rubella during pregnancy, seek immediate medical attention..
[ Read: Torch Infection During Pregnancy ]
How Is Rubella Diagnosed?
The only way to diagnose rubella is a blood test. If you are vaccinated, a blood test will help the doctor determine your immunity towards rubella based on the antibodies present in your body.
1. Serologic testing:
A blood test helps determine the number of rubella antibodies, i.e., IgG and IgM present in your body (6).
The test is conducted after seven to ten days after the onset of rubella. The IgM antibodies in the blood are at their peak during the infection and then come down after a few weeks. The blood test will be done again after two to three weeks to determine the antibody concentration.
The IgG antibodies will appear only after the IgM antibodies show their presence. Once the IgG antibodies appear, these antibodies remain traceable lifelong.
Interpretation of serological tests for rubella (7):
i. Rubella IgG negative (non-immune): If the concentration of IgG antibodies were ≤ 10 IU/mL, it means the person is either not vaccinated against rubella or never been exposed to this infection.
ii. Rubella IgG positive (immune): If the concentration of IgG antibodies were ≥ 10 IU/mL, it indicates exposure to vaccination or the infection before.
iii. Rubella IgM negative: If there is very low or no IgM antibodies present with a slight increase in IgG antibodies titer, then it indicates the possibility of reinfection.
iv. Rubella IgM positive: If the IgM antibodies (≥ 0.3 IU/mL) (8) appears along with or without IgG antibodies then it indicates a recent rubella infection.
2. Viral culture:
Another test to diagnose rubella is a viral culture. It involves the testing of a body fluid sample like throat swab or nasal swab to detect the RNA of rubella virus for confirming infection.
The doctor will determine if you have rubella or not based on the results. If you are infected with the virus, the doctor may base their recommendations on the level of antibodies in your body.
How Is Rubella Managed During Pregnancy?
The first step towards managing rubella is to determine the woman’s gestational age and her immunity against the rubella virus (9).
| Gestational period | Immunization (yes/ no) | Management |
|---|---|---|
| More than 12 weeks | Yes | No further testing is required as CRS is not reported beyond 12 weeks of gestation |
| Less than 12 weeks | Yes |
|
| Less than 16 weeks | No/ unknown |
|
| 16 to 20 weeks | No/ unknown | As the risk of CRS in the baby is less than 1%, the mother needs to be counseled appropriately |
| Above 20 weeks | No/ unknown | No proof of CRS. The mother needs to be reassured on the safety of her baby |
| Late presentation (rubella detected much after the mother is exposed to it) | Unknown | It becomes impossible to determine when it has occurred and the likely harm done to the baby. However, IgM and IgG testing may be done |
The management of rubella during pregnancy largely depends on counseling by your doctor based on the gestational age during which you have contracted the virus.
Does Rubella Have A Treatment?
There are no effective methods of treating rubella (10). However, its symptoms can be addressed. If you are exposed to the infection and do not wish to terminate your pregnancy, then the doctor might give you a shot of rubella antibodies known as hyperimmune globulin (11).
Though this shot cannot prevent your baby from getting infected, it can help reduce the birth defects to some extent. Also, you will be referred to a maternal-fetal medicine specialist (MFM), once rubella infection is confirmed.
As soon as the baby is born, she will be attended by a team of specialists, who will monitor her health.
There is nothing much you can do once you contract the virus. Hence the best way to deal with it is to take every measure to prevent it.
How Can You Prevent Rubella While Pregnant?
The best way to prevent rubella is to get vaccinated before you get pregnant. If you got the vaccination done as a child, then the chances of getting the infection are negligible.
If you are planning to get pregnant but are not sure whether or not you are vaccinated, then your doctor might suggest a blood test to examine the antibodies in it.
However, if you have not been vaccinated earlier, then here are the various scenarios:
- Before getting pregnant: Take the MMR vaccine (measles, mumps, and rubella) shot four weeks before getting pregnant.
- During pregnancy: You should not take the vaccine during pregnancy. Therefore:
- avoid close contact with people infected with rubella
- inform the doctor immediately if you have come in contact with someone with rubella-like symptoms
- After pregnancy: Get the vaccination soon after the childbirth to prevent rubella in the future pregnancies.
Here are a few more things you can do to reduce the chances of contracting rubella during pregnancy:
- If you find someone with rashes on their face or body, along with signs such as watery or red eyes, cold, runny or stuffy nose, avoid any contact with them.
- Get your children vaccinated against rubella.
- If there is an outbreak of rubella in the places that you work or live then stay away from that place. Avoid sending your kids to school for some days as they may contract the disease and pass it on to you.
- Avoid traveling to places where there is an outbreak of rubella.
- Do not use public toilets or attend public gatherings, where there are higher chances of getting the virus.
Below, we have answers to a few more questions that pregnant women have on rubella.
Frequently Asked Questions
1. What does rubella titer in pregnancy mean?
Rubella titer is a screening tool used to determine the vulnerability of a person to this infection. If you are planning a pregnancy, then this screening test will help you know if you have or lack immunity towards rubella.
Rubella titer values are determined through hemagglutination inhibition (HAI). Hemagglutination is defined as the clustering of red blood cells due to specific antibodies, virus, or other substance.
| HAI ratio (12) | Immunity |
|---|---|
| Less than 1:8 | Not immune to rubella |
| Greater than 1:20 | Immune to rubella |
2. What if I had rubella vaccine during pregnancy?
If you have had the rubella vaccine unknowingly during pregnancy or while planning one, it may not show any adverse effect on the fetus. However, there are 1.3% chances of theoretical risks of fetal birth defects if the vaccine is administered two weeks before or four to six weeks after conception. This percentage is less compared to the risks of rubella infection during the first 20 weeks of gestation (12).
However, the safest time to have a rubella vaccine is four weeks before pregnancy.
3. Do I need to get a rubella booster before pregnancy?
If you were born in or after 1957, then you need to take at least one dose of rubella vaccine. Consult your doctor to know if you need a booster dose. She would test your blood samples for the antibodies and may suggest a booster dose before pregnancy if the levels are low (13).
[ Read: Types Of Rashes During Pregnancy ]
4. Can I get a false-positive test for rubella IgM antibodies?
It is possible to get a false positive result for rubella IgM antibodies during pregnancy, due to an infection caused by other viruses. This causes the test components to cross-react with the other proteins present in the body. However, an IgG/IgM test will be carried out again after five to ten days to check for any significant increase in the amount of IgG/IgM antibodies. If there is no increase in the IgG level, it indicates a false-positive test (14).
We may choose to ignore rubella during normal times as it subsides within a few days. However, that cannot be the case during pregnancy. Do not neglect the symptoms; get a blood test done and the reports analyzed by an expert. If you have not been vaccinated for rubella in your childhood, then do not miss the vaccine weeks before getting pregnant.
Do you have any experience to share? Let us know in the comment section.
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