Rubella in pregnancy

Rubella Vaccine and Pregnancy - Dr. Hema Divakar (April 2019).


What are rubella?

Rubella is a viral infection. It is transmitted by coughing and sneezing, and a pregnant woman can infect her unborn baby (NICE 2013, Nayeri 2013).

Can it harm my baby if I get rubella during pregnancy?

It is a mild disease for adults and children but it is very dangerous for unborn babies.

However, the risk of illness is very low, as most people in Germany are vaccinated against rubella (NICE 2013, HPA 2011, NHS 2013a, NHS 2013b).

The risk is greatest if you get rubella in your first few months of pregnancy. There is also a risk of miscarriage (NICE 2013, NHS 2013a, NHS 2013b, PHE 2013).

Even if there is no miscarriage, your baby may experience congenital rubella syndrome (CRS), which can lead to various severe disabilities. If you get the virus in later pregnancy, the risk is significantly lower.

Nine out of ten babies whose mothers got infected in the first ten weeks of their pregnancy got CRS (NICE 2013, NHS 2013a, NHS 2013b, PHE 2013).

Between eleven and 16 weeks of gestation, the risk of illness drops significantly, with about one or two babies in 10 developing CRS. This also applies to the risk of disabilities, which are less frequent (NICE 2013, NHS 2013a, PHE 2013).

If there is an infection between weeks 16 and 20, the risk of CRS infection is very low. The most common disability that could result from this is deafness (NHS 2013a, PHE 2013).

After 20 weeks of pregnancy, the risk for unborn children seems to be averted, there are no known diseases with CRS (NICE 2013, HPA 2011, NHS 2013a).

The following problems with CRS can be:

  • Eye problems, such as cataracts
  • Brain damage and a very small head (microcephaly)
  • Low growth during pregnancy
  • Malformations of the Heart
  • Deafness
  • (NICE 2013, Nayeri 2013, NHS 2013a, NHS 2013b, PHE 2013)

CRS can also affect a baby's lungs, as well as the liver and skeleton (NICE 2013, NHS 2013a, PHE 2013).

Sometimes it's also the case that the effects of CRS are not visible right after birth but only when the baby is older (NHS 2013a, PHE 2013).

How do I know I have rubella?

First of all, do not worry too much, because you're probably immune to rubella. About half of the patients have no symptoms and therefore they do not know that they have rubella (Nayeri 2013). If symptoms do occur they might be:

  • mildly elevated temperature
  • sore, swollen eyes (conjunctivitis)
  • Cold symptoms such as runny nose, sore throat, and / or coughing
  • feel limp
  • swollen lymph nodes in the neck area
  • sore joints
  • (NICE 2013, Nayeri 2013)

After a few days, a rash develops in the form of red spots on the neck and face that can trigger itching.The rash can also spread to other parts of the body and will last for several days (NICE 2013).

If you notice a rash during pregnancy, always: Show it to your midwife or doctor immediately.

How can I tell if I am immune to red blood cell viruses?

If you've been vaccinated against rubella or you've had it before, then it's pretty sure they have antibodies against it. Although very rare, there is occasionally a slight increase in rubella infections, especially in women who are not born in Germany (Wise 2013) or those who have not been vaccinated or who have not had a booster dose. It could also be that the immune protection diminishes after a vaccine or through illness after some time. (NHS 2013b).

If you have not been twice vaccinated against rubella, your gynecologist will recommend a blood test to check the status of your immunization as part of your screening (NHS 2013b, NICE 2008).

What do I do if I'm not immune to rubella?

If you're not immune, you can get vaccinated - but before you get pregnant. After vaccination, you should wait one month to try to get pregnant (PHE 2013).

If you are already pregnant then you should protect yourself by avoiding anyone with rubella. If you are worried that you have come too close to a patient, then consult your gynecologist immediately.

Otherwise, wait for the vaccine until your baby is born (PHE 2013). You may be vaccinated while breast-feeding, immunization does not pose a risk to your baby (PHE 2013).

If, in fact, you get this vaccine in the first few weeks of your pregnancy because you did not know you were pregnant, try to stay calm. There are no reports of babies receiving CRS in these circumstances (PHE 2013).


HPA. 2011. Guidance on viral rash in pregnancy: Investigation, diagnosis and management of viral rash illness, or exposure to viral rash illness, in pregnancy . Health Protection Agency.

Nayeri U, Thung S. Congenital fetal infections. In: A DeCherney and N Lufer. eds. Current diagnosis and treatment: Obstetrics and gynecology . Eleventh edition (international). McGraw-Hill, 2013

NICE. 2010. Antenatal care: Routine care for the healthy pregnant woman . National Institute for Health and Care Excellence.

NICE. 2013. Clinical knowledge summary: Rubella . National Institute for Health and Care Excellence.

NHS. 2013a. Complications of rubella .

NHS. 2013b. Can rubella (German measles) harm my baby during pregnancy? NHS Choices.

PHE. 2013. Rubella. In: Immunization against Infectious Disease: The Green Book Chapter 28. Public Health England.

Wise J. 2013. Small rise in rubella cases triggers warning. BMJ 346: f2935.

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