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Patient education: Avoiding infections in pregnancy (Beyond the Basics)

Patient education: Avoiding infections in pregnancy (Beyond the Basics)
Author:
Richard H Beigi, MD, MSc
Section Editor:
Charles J Lockwood, MD, MHCM
Deputy Editor:
Milana Bogorodskaya, MD
Literature review current through: Nov 2022. | This topic last updated: Dec 20, 2021.

INTRODUCTION — Like all adults and children, pregnant people are at risk for developing viral and bacterial infections. Infections are a particular concern during pregnancy since some infections are more severe in pregnant people or may harm the fetus or newborn. However, you can take steps to decrease the chance of developing a potentially harmful illness during pregnancy.

AVOIDING EXPOSURE TO INFECTIOUS DISEASES DURING PREGNANCY — The following practices can help reduce the chance of exposure to infections known to have the potential to cause problems during pregnancy.

Hygiene — You can get infections by person-to-person contact, such as kissing, sexual contact, and handling another person’s body fluids (eg, saliva or urine) and then touching their eyes, nose, or mouth. Good hygiene practices, such as frequent hand washing and avoiding contact with another person's saliva through shared foods, drinks, or utensils, can lessen your chances of becoming infected with potentially harmful illnesses.

Good hygiene is particularly important for pregnant people who have young children or work with them, as in day care centers or schools. Some potentially harmful infections, such as cytomegalovirus, are more prevalent in young children.

Hand washing — Hand washing is an essential and very effective way to prevent the spread of infection. Hands should be washed before and after touching raw foods and eating, after going to the bathroom, after changing a diaper or assisting a child with toileting, after wiping a young child’s nose or drool, after handling garbage or dirty laundry, after touching animals or pets, after handling children’s toys, after contact with another person’s saliva, and after gardening or touching dirt/soil.

Hands should be wet with water and a plain or antimicrobial soap and then rubbed together for at least 20 seconds (table 1). Pay special attention to the fingernails, between the fingers, and the wrists. Rinse the hands thoroughly and, ideally, dry with a single use towel.

Alcohol-based hand gels are a good alternative for disinfecting hands if a sink is not available or if time does not allow for thorough hand washing. Spread hand rubs over the entire surface of hands, fingers, and wrists until dry. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, visibly soiled hands should be washed with soap and water.

Food precautions — The US Food and Drug Administration provides free online information on Food Safety for Pregnant Women. In particular, products made from unpasteurized milk, raw cookie dough or cake batter, raw or undercooked meat or fish or shellfish, unpasteurized juice or cider, cold deli meats, raw sprouts, and store-made meat/seafood salads can contain bacteria that may be harmful during pregnancy. Raw fruits and vegetables should be washed before consuming.

Expert groups like the Food Safety and Inspection Services (www.fsis.usda.gov) and the Centers for Disease Control and Prevention also have guidelines for food safety for everyone, not just pregnant people. These food precautions are discussed in more detail separately. (See "Patient education: Foodborne illness (food poisoning) (Beyond the Basics)", section on 'Foodborne illness prevention'.)

Insect borne illnesses — Pregnant people should take precautions that reduce the risk of acquiring mosquito-borne infections such as West Nile virus, Dengue virus, malaria, and Zika virus. (See "Patient education: West Nile virus infection (Beyond the Basics)".)

Mosquito bites can be prevented by wearing protective clothing and using screens or netting when in areas inhabited by mosquitoes, avoiding the outdoors when mosquitoes are most active (dawn and dusk), and use of DEET-based insect repellents. DEET is the most effective insect repellent currently available. Products with 10 to 35 percent DEET are adequate in most circumstances. Used as recommended, DEET has an excellent safety record. Pregnant and breastfeeding people can use DEET. There have been no studies of picaridin use in pregnant people.

Updated information regarding mosquito repellents is available from the CDC at www.cdc.gov/ncidod/dvbid/westnile/RepellentUpdates.htm.

Sexually transmitted infections — Your risk of being infected with a sexually transmitted infection may increase if you have more than one sexual partner or if your partner has more than one sexual partner. If your partner may have other sexual partners, you should ask them to wear a condom to reduce the chance of getting a sexually transmitted infection, or you can use an internal (female) condom. You should avoid having sex, even with a condom, if your partner has signs of a sexually transmitted infection, such as discharge from the penis, pain when urinating, or blisters or sores on the genital skin. (See "Patient education: Genital herpes (Beyond the Basics)" and "Patient education: Gonorrhea (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Genital warts in women (Beyond the Basics)".)

People who use recreational drugs can acquire infections such as hepatitis and HIV from needle sharing, then transmit these infections through sexual contact.

Travel — Avoiding travel to high-risk locations is one way to minimize the chances of becoming infected with certain infectious diseases, such as malaria, yellow fever, and Zika virus. The possibility of acquiring a food- or water-borne infectious disease is also higher in some parts of the world. For example, unpasteurized cheese is more widely available in France than in the United States. If you are planning international travel during pregnancy, it's a good idea to consult with a travel clinic about infection-related issues for your planned destination(s). (See "Patient education: General travel advice (Beyond the Basics)".)

Vaccination — Ideally, it is best to be up-to-date on your immunizations before getting pregnant. Some immunizations, such as influenza, pertussis, COVID-19, and hepatitis B, can and should be given during pregnancy. Other people living in your household, including children, should also be up to date with their immunizations; this decreases your risk of exposure to infections during pregnancy as well as your and your baby’s risks of exposure to infection after birth. More information about vaccinations during pregnancy is available separately. (See "Patient education: Vaccination during pregnancy (Beyond the Basics)".)

Animal borne illnesses — People who are pregnant or planning pregnancy should avoid contact with all rodents (and rodent droppings) and should not change cat litter boxes (or should wear gloves and then wash their hands when changing the litter box). Precautions about handling pets and laboratory animals should be discussed with a healthcare provider. (See "Patient education: Animal and human bites (Beyond the Basics)".)

Airborne infections — Some infections are transmitted when a person inhales droplets containing germs that an infected person coughs or sneezes into the air. Minimizing close contact with an ill person and wearing a mask can reduce transmission. Good hand washing also decreases the chance of infecting oneself after touching surfaces with germ-containing droplets.

INFECTIONS — Several infectious diseases can cause problems in pregnancy. Some of these infections can be prevented with a vaccine. For infections that cannot be prevented with a vaccine, we recommend practicing good hygiene and avoiding direct contact with infected individuals (when possible) to avoid infection.

Parvovirus B19 (Fifth disease) — Parvovirus B19 infection, also known as "fifth disease," is a common childhood viral infection. Since the infection is common during childhood, 40 to 60 percent of people are already immune by the time they become pregnant and are therefore not at risk for acquiring parvovirus infection.

In adults, parvovirus causes mild to severe symptoms, including joint pain, fatigue, and body aches. A rash may appear on the face, trunk, arms, and legs. The rash on the face can be intensely red as though the person had been slapped (this is called a "slapped cheek" appearance). The illness generally resolves without treatment.

It is difficult to avoid contact with people who are infected with parvovirus because the infection is common in the community and infected people are contagious before symptoms develop. Frequent hand washing and avoiding shared food, drinks, or utensils can help to prevent infection.

If you are exposed to parvovirus during pregnancy and you have not been tested previously, a blood test for parvovirus is recommended. A positive test soon after exposure means that you had the infection in the past and are now immune, so the fetus is protected from infection. If blood testing is initially negative, it may be repeated three to four weeks later to confirm that you have not developed the infection.

Pregnant people who become infected with parvovirus are monitored closely for signs of complications. Rarely, parvovirus can cause a miscarriage (pregnancy loss), fetal anemia (low blood count), or fetal heart problems.

Cytomegalovirus infection (CMV) — Cytomegalovirus (CMV) is a virus that is transmitted by sexual contact or close contact with an infected person's saliva, urine, or other body fluids. Being infected with CMV causes few or no problems in people with a healthy immune system. However, the virus can cause serious problems for infants born to people who are infected with CMV during pregnancy. The risk of becoming infected with CMV for the first time is higher for pregnant people who live with young children or work in day care centers.  

Currently, there is no way to prevent CMV infection. Medications to treat CMV in newborns are currently being studied. Vaccines against CMV are also being tested, but are not yet available. Good hygiene practices, especially hand washing, are important to decrease the chances of developing CMV infection during pregnancy. Guidelines from the Centers for Disease Control and Prevention (CDC) are available at www.cdc.gov/cmv/index.html, and include the following:

Wash your hands often with soap and water, especially after changing diapers, feeding a young child, wiping a young child’s nose or drool, and handling children’s toys

Don’t share food, drinks, or eating utensils with young children

Don’t put a child’s pacifier in your mouth

Don’t share a toothbrush with a young child

Avoid contact with saliva when kissing a child

Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva

If you develop a low-grade fever, sore throat, enlarged lymph nodes, and fatigue while pregnant, see your doctor or nurse. You may be tested for CMV with a blood test.

Most pregnant people with CMV do not need to be treated with antiviral therapy. Maternal antiviral therapy does not prevent fetal disease or reduce the risk of complications in the newborn.

There is a low risk of passing CMV infection to a newborn through breastfeeding. However, the benefits of breastfeeding outweigh the minimal risk of passing CMV through breast milk. (See "Patient education: Deciding to breastfeed (Beyond the Basics)".)

Toxoplasmosis — Toxoplasmosis is a parasitic illness that usually causes no symptoms. However, toxoplasmosis can affect the fetus if a person becomes infected during pregnancy.

Pregnant people should avoid eating rare and uncooked meat, which can be a source of this parasite. House cats can also carry toxoplasmosis in their feces. If you are pregnant, try to have someone else change the litter box if possible, or wear gloves and then wash your hands carefully afterwards. It is also important to wear gloves while gardening and to wash your hands after working in the yard since the soil can be contaminated by cat feces.

Listeria — Listeria is a bacterial infection that can cause fetal death, premature (preterm) birth, or newborn infection. It can be passed from an infected person to their fetus through the blood. Signs and symptoms of Listeria include fever, chills, and back pain; a flu-like illness is the most common symptom. (See "Patient education: Foodborne illness (food poisoning) (Beyond the Basics)", section on 'Listeria monocytogenes'.)

Most people who become infected with Listeria have eaten food that is contaminated. Contaminated foods do not appear rotten or spoiled and it is not possible to know, based upon appearance or smell, if a food is safe. For this reason, people who are pregnant are advised to avoid foods that could contain Listeria (table 2).

Chickenpox and rubella — If you have had chickenpox (varicella) and rubella, you do not have to worry about getting infected again during pregnancy. If you have not had these infections or vaccines to protect you from these infections, be sure to avoid contact with anyone with these infections, as they can be easily spread from person to person. These infections can be serious for both the mother and baby. However, if a nonimmune nonimmunized pregnant person is exposed to an individual with chickenpox, a treatment called VariZIG, a purified human immune globulin preparation, can be given as soon as possible within 10 days of exposure. This can reduce the risk of developing varicella infection and decrease the severity of infection in those who become infected.

Vaccination to protect you from chickenpox or rubella is not safe during pregnancy and should ideally be done prior to getting pregnant or immediately after delivery to protect future pregnancies. (See "Patient education: Chickenpox prevention and treatment (Beyond the Basics)".)

Group B streptococcus — Many women normally carry group B streptococcus in their vagina and/or rectum. Although this does not cause any symptoms, you can transmit the bacteria to the baby during birth. This can cause a serious newborn infection. For this reason, pregnant people are checked for group B streptococcus a few weeks before expected delivery and, if they carry the bacteria, are given antibiotics during labor to prevent the baby from getting infected. (See "Patient education: Group B streptococcus and pregnancy (Beyond the Basics)".)

Genital herpes — People who get genital herpes for the first time near the end of pregnancy or have genital lesions when they go into labor can transmit the infection to the baby during vaginal birth. Herpes infections in newborns can be very serious. If you or your partner has a history of genital herpes, talk to you doctor about the risk of newborn infection and ways to prevent it. (See "Patient education: Genital herpes (Beyond the Basics)".)

Hepatitis — There are several types of hepatitis. Hepatitis infection can be acquired in several ways, including sexually, by blood transfusion, by sharing needles, or during birth. If you or your partner has a history of hepatitis, talk to your doctor about the risk of newborn infection and ways to prevent it. (See "Patient education: Hepatitis A (Beyond the Basics)" and "Patient education: Hepatitis B (Beyond the Basics)" and "Patient education: Hepatitis C (Beyond the Basics)".)

HIV — HIV can be passed from a mother to the baby during pregnancy and birth. If you have HIV, appropriate treatment and pregnancy care can reduce this risk to a very low level. For this reason, it is important for all pregnant people to be tested for HIV. (See "Patient education: HIV and pregnancy (Beyond the Basics)".)

Zika virus — Zika virus is transmitted predominantly by mosquitoes infected with the virus, but sexual transmission from an infected partner or transmission from transfusion of blood from an infected donor can also occur. Maternal infection during pregnancy, especially early in pregnancy, may lead to fetal infection and pregnancy loss or serious birth defects, such as microcephaly (small head and brain) and impaired vision and hearing. Fetal infection can occur even if the mother has no symptoms of infection (fever, rash, conjunctivitis, muscle and joint pain, fatigue, headache).

Pregnant people can reduce their risk of infection by avoiding travel to areas with mosquito transmission of Zika virus, protecting themselves from mosquitos (see 'Insect borne illnesses' above), and using abstinence or condoms during pregnancy if their sex partner has traveled to or lives in an area with risk of Zika virus infection.

You should tell your health care provider promptly if you or your partner may have been exposed to Zika virus because of travel to or residence in an area where the virus is known to occur. Laboratory tests can be done to see if you have been infected and ultrasound examination can be performed to see if your baby appears to be developing normally.  

Flu — Getting the influenza (flu) vaccine each year is important because pregnant people with influenza are more likely to develop severe illness and to die than nonpregnant people with influenza. Maternal vaccination also reduces the risk of stillbirth and protects the newborn baby from influenza for several months after birth. The safety of influenza vaccine in pregnancy is well established; no specific concerns for pregnant people, their fetuses, infants, or school-age children have been identified in dozens of research studies and monitoring systems worldwide. (See "Patient education: Influenza prevention (Beyond the Basics)".)

COVID-19 — Coronavirus disease 2019 (COVID-19) is an infection caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can cause a fever, cough, and trouble breathing, along with other symptoms. Some people get severely ill from COVID-19; pregnant people are more likely to develop severe illness due to COVID-19 compared with nonpregnant people.

Complete vaccination against COVID-19, as well as a booster dose, is recommended for pregnant people to reduce the likelihood of becoming infected as well as reduce severity of illness. You can further protect yourself by avoiding people who are sick, washing your hands frequently, and wearing a face covering in crowded public places. (See "Patient education: Vaccination during pregnancy (Beyond the Basics)".)

TREATMENT OF INFECTIONS DURING PREGNANCY — The safety and availability of treatment for infection during pregnancy depends upon the type of infection you have and the risk of harm (from either the treatment or the infection) to you and your fetus.

It's important to discuss any concerns about infections or treatments with your health care provider.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Vaccines and pregnancy (The Basics)
Patient education: How to plan and prepare for a healthy pregnancy (The Basics)
Patient education: Erythema infectiosum (fifth disease) (The Basics)
Patient education: Malaria (The Basics)
Patient education: COVID-19 and pregnancy (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Foodborne illness (food poisoning) (Beyond the Basics)
Patient education: West Nile virus infection (Beyond the Basics)
Patient education: Genital herpes (Beyond the Basics)
Patient education: Gonorrhea (Beyond the Basics)
Patient education: Chlamydia (Beyond the Basics)
Patient education: Genital warts in women (Beyond the Basics)
Patient education: General travel advice (Beyond the Basics)
Patient education: Vaccination during pregnancy (Beyond the Basics)
Patient education: Animal and human bites (Beyond the Basics)
Patient education: Deciding to breastfeed (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Prevention of early-onset group B streptococcal disease in neonates
Clinical manifestations and diagnosis of Listeria monocytogenes infection
Group B streptococcal infection in pregnant individuals
Immunizations during pregnancy
Intraamniotic infection (clinical chorioamnionitis)
Overview of TORCH infections
Prevention of arthropod and insect bites: Repellents and other measures
Rubella in pregnancy
Toxoplasmosis and pregnancy
Treatment and prevention of Listeria monocytogenes infection
Varicella-zoster virus infection in pregnancy
Parvovirus B19 infection during pregnancy
Cytomegalovirus infection in pregnancy
Congenital cytomegalovirus infection: Clinical features and diagnosis

The following organizations also provide reliable health information.

National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

Centers for Disease Control and Prevention (CDC)

     Toll-free: (800) 311-3435
     (www.cdc.gov)

Infectious Diseases Society of America

     (www.idsociety.org)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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