When you're likely to worry about your developing baby's health as much as your own. Fortunately, you may already be immune to a number of contagious diseases. And thanks to a successful vaccination program, German measles — the most dangerous infection of all for a developing baby — is now very rare in this country.
Although you can't avoid all infections while you're pregnant, you can take certain steps to make it less likely that you'll get sick and reduce the risk of serious problems for you or your baby if you do get an infection. Getting prenatal care is crucial. For example, simple blood tests can tell you whether you're immune to certain infections.
There's a simple test for women nearing the end of their pregnancy that could save the life of their newborn child.
With a swab of a woman's rectum and vagina, doctors can determine whether she carries a type of bacteria called Group B streptococcus, or GBS.
If not properly treated with antibiotics, GBS can transfer from mother to child prior to or during birth, with potentially severe health consequences for the newborn that can include blindness, deafness, retardation, physical disability and even death.
The test has become a standard part of prenatal care, with universal screening of all pregnant women at 35 to 37 weeks of pregnancy. And doctors and health experts are recommending that women take matters into their own hands to protect their unborn children from GBS.
"You have to be an advocate for yourself," if you've been told you carry the germ, said Dr. Carol Baker, a professor of pediatrics, microbiology and immunology at the Baylor University College of Medicine, and head of the section for infectious diseases in the college's Department of Pediatrics. "Say, 'I'm group B strep positive, and need my antibiotics now.' "
"They need to start as soon as possible after you arrive in labor. When you arrive you shouldn't be filling out paperwork. You should be getting your antibiotics," Baker said.
GBS is a relatively common germ that is rarely dangerous to adults, but can be life-threatening to newborns. An estimated 10 percent to 30 percent of pregnant women carry the bacterium. It's the most frequent cause of sepsis and meningitis in newborns; it easily latches on to birth tissues, infecting babies that come into contact with the germ before or during birth.
About three of every 10,000 babies born in the United States contracted GBS in 2004, according to the U.S Centers for Disease Control and Prevention.
"The good news is that mortality is only 5 percent," Baker said. "This is a high mortality -- one in 20 babies die -- but it used to be 50 percent."
Half of all infants who develop meningitis through Group B strep suffer lasting neurologic damage that can include cerebral palsy, sight and hearing loss, mental retardation, learning disabilities and seizures, according to the March of Dimes.
Current treatment involves early detection through screening, followed by intravenous antibiotics administered to the mother prior to birth. This is part of a new protocol issued by the CDC in 2002 to help cut down on the number of babies infected by GBS.
However, the antibiotic needs to be administered at least four hours prior to delivery if doctors want to be sure of killing off the bacteria. Women sometimes don't arrive at the hospital early enough to start their IV antibiotics, Baker said. Children born prematurely before their mothers have received the screening also run the risk of exposure to GBS.
"We need to figure out better techniques to prevent even greater numbers of babies from getting infected," said Dr. James A. McGregor, visiting professor of clinical obstetrics and gynecology at the University of Southern California Keck School of Medicine in Los Angeles.
Doctors have been researching a way to prevent GBS through a vaccine administered to either pregnant women or women of childbearing age, but those efforts have stalled, Baker said.
Such a vaccine would work by introducing GBS-resistant antibodies into the mother that would then be passed on to the child during pregnancy. A decade-long collaborative study between Baylor and Harvard University and funded by the National Institutes of Health prepared such vaccines, and a small pregnancy trial found them to be safe and effective, Baker said.
But no drug company has stepped forward to mass-produce the vaccine, she said.
"It was the hope of the NIH that 10 years of work would result in a pharmaceutical company picking up the vaccine and developing it. That has not happened, and there is only one reason why," Baker said. "They don't want to give a vaccine to pregnant women. This is all about having too many lawyers in the United States," she said.
Pregnancy is so personal and so rife with complications that the companies are concerned they will be sued, she added. "Everyone's worried about litigation," Baker said. "They want legislation protecting them before they develop any vaccines."
With no vaccine imminent, doctors are trying to limit GBS infection by urging obstetricians and midwives to not strip the birth membranes, McGregor said. It's a traditional thing to do to induce labor, but it puts the Group B strep right up into the uterus," he said.
Another technique being investigated is treating babies right after birth with a shot of intramuscular penicillin, McGregor said.
You can also take comfort in the fact that most babies aren't harmed if their mother gets an infection during pregnancy. But some bugs can be transmitted to babies through the placenta or during birth, and when that happens, it may have serious consequences for the baby. What's more, some infections can make you sicker if you get them when you're pregnant or may lead to other complications like preterm labor.
Here's a list of some of the infections that can affect a pregnancy:
Bacterial vaginosis
Chicken pox
Chlamydia
Cytomegalovirus
Fifth disease
Flu
German measles (rubella)
Gonorrhea
Group B strep
Hepatitis B
Herpes
HIV
Listeriosis
Sexually transmitted infections
Syphilis
Toxoplasmosis
Trichomoniasis
Urinary tract infections
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