Measles and Pregnancy: A Growing Concern
In the ongoing battle against measles, a highly contagious disease, a critical strategy has emerged: vaccinating non-immune women before they become pregnant. This narrative review, published in Obstetrics & Gynecology, highlights the importance of this preventive measure.
The Challenge: Vaccination During Pregnancy
Here's where it gets controversial: vaccination during pregnancy is not recommended due to potential risks. Dr. Naima Joseph, the review's author, emphasizes that no licensed antiviral treatments exist for measles, leaving susceptible pregnant women vulnerable.
Recent Outbreaks and Their Impact
Dr. Joseph warns that recent measles outbreaks in the US, coupled with decreasing vaccination rates, have led to a higher proportion of cases among reproductive-age individuals. As of November 12, the CDC reported 1723 confirmed cases, with a significant number (573) occurring in the 20+ age group.
Pregnancy and Measles: A Dangerous Combination
Pregnancy alters a woman's immune system, making her more susceptible to respiratory infections like measles. This can lead to severe complications, including an increased risk of pneumonia and the need for respiratory support. Moreover, studies suggest a higher risk of maternal death.
Risks to the Fetus and Newborn
The risks don't stop there. Measles during pregnancy is associated with a higher chance of stillbirth and prematurity. There's also an increased risk of measles transmission to the newborn, a condition known as congenital measles, which carries a higher risk of severe disease and infant mortality.
Real-World Examples
Dr. Kevin Ault, a professor of OB/GYN, highlights a case of measles during pregnancy in the recent Texas outbreak and similar cases in Ontario, Canada. He also mentions several maternal deaths during the 1990 measles outbreak, emphasizing the severity of the disease.
Vaccination Strategies and Safety
Both the MMR and MMR-varicella vaccines are contraindicated in pregnancy due to the theoretical risk of fetal congenital rubella syndrome. However, the CDC estimates this risk to be extremely low (0%-1.6%), with only one reported case. Breastfeeding, on the other hand, is not a contraindication and may even provide protection to infants up to 3 months old.
Determining Immunity and Vaccination History
Dr. Ault stresses the importance of vaccination history in determining immunity to measles. Everyone considering pregnancy should have received the routine childhood doses of the MMR vaccine, usually two doses after turning one year old. If not, vaccination can be done as an adult, with a 30-day wait before attempting conception due to the theoretical risk of congenital infection.
The Safety and Effectiveness of the MMR Vaccine
The MMR vaccine, despite its age, has reassuring safety and effectiveness data for both children and adults. With ongoing outbreaks in the USA and Canada, the focus remains on vaccination as the primary prevention strategy.
The Role of Healthcare Providers
Dr. Joseph calls for a concerted effort by physicians and nurses to ensure all women of reproductive age have immune protection against measles. Clinicians should refer to guidelines, assess vaccine eligibility, and provide vaccination, reminding patients of the safety and effectiveness of measles vaccines in reducing infection and complications.
Conclusion
In conclusion, the review highlights the critical need for pre-pregnancy vaccination against measles, especially given the recent outbreaks and their impact on reproductive-age individuals. It's a call to action for healthcare providers to ensure the protection of women and their future offspring.
