Conditions Arising in Pregnancy

There are a number of conditions in neonates and children that are caused by problems during
the pregnancy. Prevention is the best solution to these problems, as once the fetus is affected the damage is done. Management, once they are born, depends on the individual difficulties and involves the multidisciplinary team.

 

Fetal Alcohol Syndrome

Alcohol in pregnancy can cross the placenta and enter the fetus, where is disrupts fetal development. There is no safe level of alcohol in pregnancy and mothers are encouraged not to drink alcohol at all, however small amounts are less likely to result in lasting effects. The effects are greatest 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 certain effects and characteristics that are found in children of mothers that consumed significant alcohol during pregnancy:

  • 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 and the other)
  • Learning disability
  • Behavioural difficulties
  • Hearing and vision problems
  • Cerebral palsy

 

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. If in doubt they can be tested for rubella immunity. If they do not have antibodies to rubella they can be vaccinated with 2 doses of the MMR 3 months apart.

Pregnant women should not receive the MMR vaccination, as this is a live vaccine. Non-immune women should be offered the vaccine after giving birth.

The features of congenital rubella syndrome to be aware of are:

  • Congenital cataracts
  • Congenital heart disease (PDA and pulmonary stenosis)
  • Learning disability
  • Hearing loss

 

Congenital Varicella Syndrome

Chickenpox is caused by the varicella zoster virus (VZV). It is dangerous in pregnancy because it can lead to:

  • More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis
  • Fetal varicella syndrome
  • Severe neonatal varicella infection if mum is infected around delivery

Mothers that have previously had chickenpox are immune and safe. If in doubt, IgG levels for VZV can be tested. A positive IgG for VZV indicates immunity. Women that are not immune to varicella may be offered the varicella vaccine before or after pregnancy.

Exposure to chickenpox in pregnancy:

  • If the pregnant women has previously had chickenpox, they are safe
  • If they are not sure about their immunity, test the VZV IgG levels. If positive, they are safe.
  • If they are not immune, they can be treated with IV¬†varicella immunoglobulins¬†as prophylaxis against developing chickenpox. This should be given within 10 days of exposure.

If the chickenpox rash starts in pregnancy, they may be treated with oral aciclovir if they present within 24 hours and are more than 20 weeks gestation.

Congenital varicella syndrome occurs in around 1% of cases of chickenpox in pregnancy. It occurs when there is infection in the first 28 weeks of gestation. The typical features include:

  • Fetal growth restriction
  • Microcephaly, hydrocephalus and learning disability
  • Scars and significant skin changes following the dermatomes
  • Limb hypoplasia (underdeveloped limbs)
  • Cataracts and inflammation in the eye (chorioretinitis)

 

Congenital Cytomegalovirus

Congenital cytomegalovirus (CMV) infection occurs due to maternal CMV infection during pregnancy. 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 CMV are:

  • 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. This risk is higher later in the pregnancy. There is a classic triad of features in congenital toxoplasmosis:

  • Intracranial calcification
  • Hydrocephalus
  • Chorioretinitis

 

Congenital Zika Syndrome

The zika virus is spread by host 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. 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 that may have contracted the Zika virus should be tested for the 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 January 2020
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