Hurricanes and pregnancy

Effects on Pregnant Women

INFECTIONS

Chickenpox
Cryptosporidiosis
Cytomegalovirus
Enteroviruses (Non-polio)
Giardiasis
Influenza
Leptospirosis
Lymphocytic Choriomeningitis Virus
Noroviruses
Rubella (German measles)
Toxoplasmosis
Tuberculosis
Varicella
Vibrio Infections
West Nile Virus

The risk for certain infections might be increased following a disaster such as a hurricane or other storm. Information on this website was created for women who are pregnant and concerned about the effects of certain infections on their unborn children.

For general information about possible infections after a hurricane please see http://www.bt.cdc.gov/disasters/hurricanes/infectiousdisease.asp.

Chickenpox – see Varicella


Cryptosporidiosis

Cryptosporidiosis is a diarrheal illness caused by the parasite Cryptosporidium. This parasite is found in soil, food, water, or surfaces that have been contaminated with infected human or animal feces. If a person swallows the parasite, she or he will become infected. In persons with healthy immune systems, the symptoms of cryptosporidiosis usually last about 1 to 2 weeks. The symptoms may go in cycles in which an infected person seems to get better for a few days, then feels worse again before the illness ends. Most people who have a healthy immune system will recover without treatment.

For more information about cryptosporidiosis and its prevention, please see
http://www.cdc.gov/ncidod/dpd/parasites/cryptosporidiosis/default.htm.

For information about prevention of diarrheal disease through handwashing, please see
http://www.bt.cdc.gov/disasters/hurricanes/handwashing.asp.

For more information about the management of acute diarrhea, please see
http://www.bt.cdc.gov/disasters/hurricanes/dguidelines.asp

Cryptosporidiosis and Pregnancy

It is not known if Cryptosporidium passes to the developing baby when a pregnant woman is infected. Infected adults can experience nausea, vomiting, fever, diarrhea, weight loss, and dehydration. Dehydration is a particular concern for pregnant women, who can become dehydrated easily. To help prevent dehydration, pregnant women should drink an oral rehydration solution (such as Pedialyte® or Gastrolyte® ), juices, or water in small, frequent amounts. Health care providers might want to consider the early use of intravenous fluids in pregnant women.

Nitazoxanide is a new drug approved for treatment of cryptosporidiosis in people with healthy immune systems. However, use of this drug by pregnant women has not been studied.

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Cytomegalovirus

Cytomegalovirus (CMV) is a virus that is transmitted from person to person, especially in households and among young children in day care centers.

For more information about CMV infection and its prevention, please see
http://www.cdc.gov/cmv/facts.htm.

CMV and Pregnancy

CMV is the virus most frequently transmitted to a developing child before birth. Healthy pregnant women are not at special risk for disease from CMV infection. However, their developing unborn babies are at risk for congenital CMV disease. Complications of congenital infection can include jaundice, hepatosplenomegaly (enlarged liver and spleen), neurological abnormalities, hearing and vision loss, and other complications. No specific treatment or vaccine is available for CMV. Ganciclovir treatment has been used for patients with depressed immunity, but there is no experience with its use in pregnancy.

CMV can be prevented if women practice good personal hygiene, especially handwashing with soap and water, after contact with diapers or oral secretions. The demonstrated benefits of breast-feeding outweigh the minimal risk of acquiring CMV from the breast-feeding mother.

For further information about CMV and pregnancy, please see see http://www.cdc.gov/cmv/index.htm or  http://otispregnancy.org/pdf/cytomegalovirus.pdf.

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Enteroviruses (Non-polio)

Non-polio enteroviruses are a group of small viruses that are very common. Most people who are infected with an enterovirus have no disease at all, while others can develop mild upper respiratory symptoms (a "summer cold"), fever and muscle aches, or an illness with rash. Less commonly, more severe complications can occur. There is no treatment or vaccine available for non-polio enteroviruses. General cleanliness and frequent handwashing are probably effective in reducing the spread of these viruses.

For more information about non-polio enterovirus infection and how to prevent it, please see
http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/non-polio_entero.htm.

For information about prevention of disease through hand-washing, please see
http://www.bt.cdc.gov/disasters/hurricanes/handwashing.asp.

Enteroviruses and Pregnancy

Because enteroviruses are so common, pregnant women are frequently exposed to them. Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes adverse pregnancy outcomes. However, mothers infected shortly before delivery can pass the virus on to the newborn child. Newborns infected with an enterovirus usually have mild illness; however, in rare cases, they can develop an overwhelming infection of many organs, including the liver and heart, and die from the infection. The risk of this severe illness is higher for the newborns infected during the first 2 weeks of life.

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Giardiasis

Giardiasis is a diarrheal illness caused by the parasite Giardia intestinalis (also known as Giardia lamblia). For more information about giardiasis, please see http://www.cdc.gov/ncidod/dpd/parasites/giardiasis/
factsht_giardia.htm#what.

For information about prevention of diarrheal disease through handwashing, please see
http://www.bt.cdc.gov/disasters/hurricanes/handwashing.asp.

For more information about the management of acute diarrhea, please see
http://www.bt.cdc.gov/disasters/hurricanes/dguidelines.asp.

Giardiasis and Pregnancy

While it is not known to cause infection in an unborn child, infected adults can experience weight loss and dehydration, with illness lasting 2 to 6 weeks. This is a particular concern for pregnant women, who can become dehydrated easily. To help prevent dehydration, pregnant women should drink an oral rehydration solution (such as Pedialyte® or Gastrolyte® ), juices, or water in small, frequent amounts. Health care providers might want to consider the early use of intravenous fluids in pregnant women.

Several prescription drugs are available to treat giardiasis. However, use of metronidazole is generally not recommended in the first trimester, as its safety has not been determined. For more information on the use of metronidazole during pregnancy, please see http://otispregnancy.org/pdf/Flagyl.pdf.

Although alternative medications include azithromycin and paromycin, these have not been fully studied in pregnancy.

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Influenza

Influenza, or the flu, is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. For more information about influenza infection, its treatment and prevention, please see http://www.cdc.gov/flu.

Influenza and Pregnancy

Pregnant women are considered at high risk for complications from influenza, including pneumonia and possibly preterm delivery. Historically, there have been increased deaths among pregnant women during influenza epidemics. Several new antiviral drugs are now available for treatment or prophylaxis of influenza infection, but they have rarely been used in pregnancy. The best way to prevent influenza is by getting a flu vaccination. Pregnant women should receive inactivated flu vaccine. Vaccination can occur at any time during pregnancy.

For more information on who should get the influenza vaccine, please see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5408a1.htm.

For information about vaccines recommended for pregnant women, please see http://www.cdc.gov/nip/publications/preg_guide.htm.

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Leptospirosis

Leptospirosis is an infection caused by bacteria called Leptospira. People can get from infected animals, such as rodents.

For more information about leptospirosis, please see
http://www.bt.cdc.gov/disasters/hurricanes/katrina/leptofaqs.asp.

Leptospirosis and Pregnancy

Not much is known about leptospirosis infection during pregnancy. Some studies have reported miscarriage or fetal death depending on when during pregnancy the infection occurred. Leptospirosis is usually treated with antibiotics, such as doxycycline or penicillin. However, there are some concerns with the use of doxycycline during pregnancy. Doxycycline is a tetracycline antibiotic. Potential risks of tetracyclines to fetal development include staining of the teeth and concern about possible depressed bone growth and defective dental enamel. Rarely, necrosis of the liver has been reported in pregnant women. Doxycycline use in pregnant women should be avoided in non–life-threatening illnesses when effective alternatives are available.

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Lymphocytic Choriomeningitis Virus

Lymphochoriomeningitis virus (LCMV) is carried by wild mice, as well as laboratory and pet rodents such as hamsters and guinea pigs. Most adults have mild, nonspecific symptoms (headache, fever, chills, and muscle aches) or are asymptomatic, although some develop meningitis.

For more information about LCMV infection and its prevention, please see http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lcmv.htm.

LCMV and Pregnancy

Infection during pregnancy can lead to miscarriage, fetal death, or early neonatal death. Infants with congenital LCMV infection can have microcephaly (abnormally small head), neurologic abnormalities, vision impairment, and other complications. It is not known how frequently congenital LCMV infection occurs after maternal infection during pregnancy. There is no specific treatment or vaccine available. To avoid LCMV infection, women who are pregnant or who are planning a pregnancy should avoid contact with rodents, their excreta, and nesting materials.

For further information about LCMV and pregnancy, please see http://www.cdc.gov/ncbddd/bd/lcmv.htm or
http://otispregnancy.org/pdf/LCMV.pdf.

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Noroviruses

Noroviruses cause gastroenteritis, or the “stomach flu”. Aside from feeling very sick, infected individuals can also become dehydrated by either not consuming enough fluids (due to nausea or vomiting) or losing a lot of fluids (due to diarrhea).

For more information about norovirus illness, please see
http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm.

For information about prevention of diarrheal disease through handwashing, please see
http://www.bt.cdc.gov/disasters/hurricanes/handwashing.asp.

For more information about the management of acute diarrhea, please see
http://www.bt.cdc.gov/disasters/hurricanes/dguidelines.asp.

Noroviruses and Pregnancy

Vomiting and diarrhea related to norovirus are particular concerns for pregnant women, who can become dehydrated easily. To help prevent dehydration, pregnant women should drink an oral rehydration solution (such as Pedialyte® or Gastrolyte® ), juices, or water in small, frequent amounts. Health care providers might want to consider the early use of intravenous fluids in pregnant women. Because illness is usually of short duration, symptomatic medicines such as Immodium® or Pepto-Bismol® are not recommended. In addition, effects of their use in pregnant women have not been thoroughly studied.

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Rubella (German measles)

Rubella is a disease caused by a virus that is spread by coughing and sneezing. The disease causes rash and fever usually for 2 to 3 days.

For information about rubella infection, please see
http://www.cdc.gov/nip/diseases/rubella/vac-chart.htm and
http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=rubella.htm.

Rubella and Pregnancy

Maternal rubella infection in pregnancy can cause infection in the unborn child. Fetal infection can result in neurologic abnormalities, hearing loss, cataracts, heart defects, and other problems. How severely the unborn child is affected depends on when during pregnancy the mother is infected, with the most severe effects from infection that occurs early in pregnancy. There is no specific treatment for rubella infection in the mother or infant once it occurs. However, rubella infection can be prevented through vaccination.

For more information about congenital rubella infection, please see
http://www.marchofdimes.com/pnhec/188_673.asp.

For information about vaccines recommended for pregnant women, please see http://www.cdc.gov/nip/publications/preg_guide.htm.

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Toxoplasmosis
Toxoplasmosis is a disease caused by the parasite Toxoplasma gondii that can be carried by domestic cats. Also, eating contaminated raw or partly cooked meat (especially pork, lamb or venison) puts people at increased risk for toxoplasmosis, as can drinking water contaminated with T. gondii. Most healthy people have very few have symptoms with toxoplasmosis.
For more information about toxoplasmosis and how to prevent infection, please see
http://www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/
factsht_toxoplasmosis.htm.

Toxoplasmosis and Pregnancy
Maternal toxoplasmosis during pregnancy can lead to infection in the unborn child. Fetal infection can result in jaundice, hepatosplenomegaly (enlarged liver and spleen), neurologic abnormalities, hearing and vision loss, and other problems. Spiramycin, pyrimethamine, and sulfadiazine have been used to treat maternal infection during pregnancy, but the potential risks of these drugs to the unborn child have not been fully studied. The decision to use them during pregnancy should be made on an individual basis.
For more information about toxoplasmosis and pregnancy, please see http://www.cdc.gov/ncbddd/pregnancy_gateway/infection_toxo.htm or  http://otispregnancy.org/pdf/toxoplasmosis.pdf.

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Tuberculosis

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis.  Untreated active TB is spread through the air from one person to another.

For more information about tuberculosis, please see
http://www.cdc.gov/tb/faqs/default.htm.

Tuberculosis and Pregnancy

Infants born to women with untreated TB can be of lower birth weight than those born to women without TB. In rare cases, the infant can be born with TB. Untreated TB poses a greater risk to a pregnant woman and her baby than does its treatment. However, streptomycin should not be used because it has been shown to have harmful effects on the unborn child. In most cases, pyrazinamide is not recommended for use because its effect on the unborn child is unknown.

For more information about TB infection and its treatment during pregnancy, please see
http://www.cdc.gov/tb/pubs/tbfactsheets/pregnancy.htm.

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Varicella (Chickenpox)

Varicella, also known as chickenpox, is a virus infection that causes a rash that looks like blisters, itching, tiredness, and fever. It spreads easily from person to person by touching or through the air from coughing or sneezing. Most people who get chickenpox are less than 15 years old. Adults, babies, teenagers, and people with weak immune systems are more likely to have a serious case. Severe chickenpox can cause other problems, such as pneumonia or swelling of the brain. Chickenpox may also be worse in pregnant women, putting them at risk for other problems.

Most people get chickenpox only once in their lives. People who have never had chickenpox can get a vaccine to prevent the disease. Most people who get the vaccine will not get chickenpox. Those who do get sick usually have a very mild case. A special treatment called VZIG (varicella zoster immune globulin) can be given to someone who has been exposed to chickenpox. VZIG can prevent or lessen the illness. It is used in people who are more likely to become very sick. VZIG must be given no more than 4 days after someone is exposed. Once a person gets sick, a medicine called acyclovir can be used to treat chickenpox. It is used in people who are more likely to get very sick. A person must take acyclovir no more than 24 hours after the chickenpox rash first appears.

To learn more about chickenpox and varicella vaccine, please see
http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm.

Varicella and Pregnancy
Pregnant women who have never had chickenpox can get it during pregnancy. A small percentage of women who get chickenpox in the first 6 months of pregnancy can have babies with birth defects. These include a limb (arm or leg) that doesn’t develop normally, scarring of the skin on a limb, neurologic problems, and eye problems. The risk is highest when the mother has chickenpox between 13 and 20 weeks of pregnancy. In addition, pregnant women may get very sick from chickenpox and be at risk for other problems.

Pregnant women should not get the vaccine for chickenpox because it contains a live, but weak, form of the virus. The best way to protect a pregnant woman who has not had chickenpox is to vaccinate close contacts, such as family members, who have never had chickenpox. VZIG may be used for pregnant women who have never had chickenpox and have been exposed. The use of acyclovir during pregnancy is not known to harm an unborn child, but it has not been fully studied. Health care providers may think about using it in pregnant women who have a serious case of chickenpox with complications.

To learn more about chickenpox and pregnancy, please see http://www.cdc.gov/ncbddd/pregnancy_gateway/infection_chickenpox.htm or
http://www.cdc.gov/nip/vaccine/varicella/faqs-clinic-vac-preg.htm or
http://otispregnancy.org/pdf/chickenpox.pdf.

For information about vaccines for pregnant women, please see http://www.cdc.gov/nip/publications/preg_guide.htm.

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Vibrio Infections

V. vulnificus is naturally present in warm coastal waters and can cause wound infections and sometimes severe illness. It can also be acquired by eating raw or undercooked seafood from such waters.

For more information about V. vulnificus infection, please see
http://www.bt.cdc.gov/disasters/vibriovulnificus.asp.

V. vulnificus and Pregnancy

Infection from V. vulnificus in adults is usually treated with a combination of cephalosporin (e.g., ceftazidime) and doxycycline. However, there are some concerns about the use of doxycycline during pregnancy. Doxycycline is a tetracycline antibiotic. Potential risks of tetracyclines to fetal development include staining of the teeth and concern about possible depressed bone growth and defective dental enamel. Rarely, necrosis of the liver has been reported in pregnant women. Doxycycline use in pregnant women should be avoided in non–life-threatening illnesses when effective alternatives are available. In general, cephalosporins are not known to cause fetal abnormalities, although not all preparations have been fully studied.

Non-O1 and Non-O139 V. Cholerae

V. cholerae is naturally present in warm coastal waters and can cause diarrheal disease, wound infections, and sometimes severe illness. It can also be acquired by eating raw or undercooked seafood from such waters. V. cholerae has many different types or serogroups, only two of which can cause epidemic cholera. The other serogroups are known collectively as non-O1 and non-O139 V. cholerae.

Non-O1 and Non-O139 V. cholerae and Pregnancy

Individuals infected with non-O1 and non-O139 V. cholerae who experience diarrheal disease can become dehydrated. This is a particular concern for pregnant women, who can become dehydrated easily. To help prevent dehydration, pregnant women should drink oral rehydration solution (such as Pedialyte® or Gastrolyte® ), juices, or water in small, frequent amounts. Health care providers might want to consider the early use of intravenous fluids in pregnant women. In many cases, antibiotics are used to hasten the recovery. Minocycline is a tetracycline antibiotic. Potential risks of tetracyclines to fetal development include staining of the teeth and concern about possible depressed bone growth and defective dental enamel. Rarely, hepatic necrosis has been reported in pregnant women. Minocycline use in pregnant women should be avoided in non–life-threatening illnesses when effective alternatives are available. In general, cephalosporins are not known to cause fetal abnormalities, although not all preparations have been fully studied.

For more information about non-O1 and non-O139 V cholerae, please see
http://www.bt.cdc.gov/disasters/hurricanes/katrina/vibrocholera.asp.

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West Nile Virus

Most often, West Nile virus (WNV) is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite. In a very small number of cases, WNV also has been spread through blood transfusions, organ transplants, and breastfeeding, and during pregnancy from mother to baby.

For more information about WNV and its prevention, please see http://www.cdc.gov/ncidod/dvbid/westnile/index.htm.

West Nile Virus and Pregnancy

Although it is not known with certainty whether WNV causes birth defects, concern for this has been raised after a baby with birth defects was born to a woman infected with WNV during pregnancy. Laboratory tests showed that WNV had been passed to her baby. A single case does not prove that WNV causes birth defects. However, pregnant women who live in areas with WNV-infected mosquitoes should stay indoors during peak times of mosquito activity (usually dawn and dusk) and wear protective clothing. Pregnant women should apply insect repellent primarily to their clothing and, in small amounts, to exposed skin when necessary.

For more information on WNV and pregnancy, please see http://www.cdc.gov/ncidod/dvbid/westnile/DuringPregnancy/
WNV_duringPregnancy.htm.

For information on the use of insect repellents, please see http://www.cdc.gov/ncidod/dvbid/westnile/
RepellentUpdates.htm.
 

Date: July 10, 2007
Content source: National Center on Birth Defects and Developmental Disabilities