Various paediatric conditions are the direct result of problems during pregnancy. These conditions should ideally be prevented. Management depends on individual difficulties and involves the multidisciplinary team.
Fetal Alcohol Syndrome
Alcohol can cross the placenta and enter the fetus, where it disrupts fetal development. There is no safe level of alcohol in pregnancy, and mothers are encouraged not to drink alcohol at all. The effects are most significant when alcohol is consumed in the first 3 months of pregnancy.
Alcohol in early pregnancy can lead to:
- Miscarriage
- Small for dates
- Preterm delivery
Fetal alcohol syndrome refers to specific effects and characteristics that are found in children of mothers that consumed significant alcohol during pregnancy. Features include:
- Microcephaly (small head)
- Thin upper lip
- Smooth, flat philtrum (the groove between the nose and upper lip)
- Short palpebral fissure (short horizontal distance from one side of the eye to the other)
- Learning disability
- Behavioural difficulties
- Hearing and vision problems
Congenital Rubella Syndrome
Congenital rubella syndrome is caused by maternal infection with the rubella virus during pregnancy. The risk is highest during the first 3 months of pregnancy.
Women planning to become pregnant should ensure they have had the MMR vaccine. Immunity to rubella can be tested if there is doubt. When rubella antibodies are negative, further vaccination is advised before pregnancy.
Pregnant women should not receive the MMR vaccine, as this is a live vaccine. Non-immune women should be offered the vaccine after giving birth.
The features of congenital rubella syndrome include:
- Congenital cataracts
- Congenital heart disease (e.g., patent ductus arteriosus and pulmonary stenosis)
- Learning disability
- Hearing loss
Congenital Varicella Syndrome
Chickenpox is caused by the varicella-zoster virus (VZV). Infection during pregnancy can cause:
- Severe disease in the mother, such as pneumonitis, hepatitis or encephalitis
- Fetal varicella syndrome
- Severe neonatal varicella infection if mum is infected around delivery
Mothers who have previously had chickenpox are immune and safe. When in doubt, IgG levels for VZV can be tested. A positive IgG indicates immunity. Women who are not immune are offered the vaccine before or after pregnancy.
When a pregnant woman is exposed to chickenpox during pregnancy:
- Previously had chickenpox: safe
- Not sure about immunity: test the VZV IgG levels – if positive, they are safe
- Not immune: given IV varicella immunoglobulins as prophylaxis within 10 days of exposure.
Oral aciclovir is prescribed to treat the chickenpox rash in women more than 20 weeks gestation who present within 24 hours of the rash starting. It may also be considered in women under 20 weeks gestation.
Congenital varicella syndrome occurs in around 1% of cases of chickenpox in pregnancy. It occurs with infection in the first 28 weeks of gestation. The typical features include:
- Fetal growth restriction
- Microcephaly, hydrocephalus and learning disability
- Scars and skin changes following the dermatomes
- Limb hypoplasia (underdeveloped limbs)
- Cataracts and chorioretinitis (inflammation of the choroid and retina in the eye)
Congenital Cytomegalovirus
Congenital cytomegalovirus occurs due to maternal infection with cytomegalovirus (CMV). The virus is mostly spread via the infected saliva or urine of asymptomatic children. Most cases of CMV in pregnancy do not cause congenital CMV. The features of congenital cytomegalovirus include:
- Fetal growth restriction
- Microcephaly
- Hearing loss
- Vision loss
- Learning disability
- Seizures
Congenital Toxoplasmosis
Infection with the Toxoplasma gondii parasite is usually asymptomatic. It is primarily spread by contamination with faeces from a cat that is a host of the parasite. When infection occurs during pregnancy it can lead to congenital toxoplasmosis. The risk is higher in the later stages of pregnancy. There is a classic triad of features in congenital toxoplasmosis:
- Intracranial calcification
- Hydrocephalus
- Chorioretinitis (inflammation of the choroid and retina in the eye)
Congenital Zika Syndrome
The Zika virus is spread by Aedes mosquitos in areas of the world where the virus is prevalent. It can also be spread by sex with someone infected with the virus. It can cause no symptoms, minimal symptoms or a mild flu-like illness. It is advised to avoid attempting to get pregnant for a period after travelling to an area with the virus (8 weeks for women and 12 weeks for men, as the virus remains infectious longer in semen).
In pregnancy it can lead to congenital Zika syndrome, which involves:
- Microcephaly
- Fetal growth restriction
- Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy
Pregnant women who may have contracted the Zika virus can be tested with viral PCR and antibodies to the Zika virus. Women with a positive result should be referred to fetal medicine to monitor the pregnancy. There is no treatment for the virus.
Last updated May 2025
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