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

INTRODUCTION

Like all adults and children, pregnant women are at risk for developing viral and bacterial infections. Infections are a particular concern during pregnancy since some infections are more severe in pregnant women 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 cause problems during pregnancy.

Hygiene — Pregnant women 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 women 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 preparing food 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 15 to 30 seconds. 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 rubs are a good alternative for disinfecting hands if a sink is not available. 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 — Expert groups like the Food Safety and Inspection Services (www.fsis.usda.gov) and the Centers for Disease Control and Prevention have guidelines for food safety for everyone, not just pregnant women. These food precautions are detailed in a separate topic. (See "Patient information: Food poisoning (food-borne illness) (Beyond the Basics)", section on 'Food poisoning prevention'.)

In particular, unpasteurized dairy products, undercooked meat, and cold deli meats can contain bacteria that may be harmful for pregnant women.

Insect borne illnesses — Pregnant women should take precautions that reduce the risk of acquiring mosquito-borne infections (eg, West Nile virus in the United States, malaria in some tropical countries). (See "Patient information: West Nile virus infection (Beyond the Basics)".)

Mosquito bites can be prevented through use of protective clothing (or screens or netting), 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 women can use DEET.

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

Sexually transmitted infections — Pregnant women should be aware that 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. Unless you are absolutely certain that your partner has no other sexual partners and is free of sexually transmitted infections, you should ask your partner to wear a condom to reduce the chance of getting a sexually transmitted infection, or you can use a 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 information: Genital herpes (Beyond the Basics)" and "Patient information: Gonorrhea (Beyond the Basics)" and "Patient information: Chlamydia (Beyond the Basics)" and "Patient information: Genital warts in women (Beyond the Basics)".)

Users of recreational drugs can acquire infections such as hepatitis and HIV from needle sharing and 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. In some parts of the world, polio, yellow fever, and malaria are still common. 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. Women who are planning international travel during pregnancy should consult with a travel clinic about infection-related issues for the planned destination. (See "Patient information: General travel advice (Beyond the Basics)".)

Immunization — You should be up-to-date on your immunizations before pregnancy. Some immunizations, such as influenza and pertussis, can and should be given during pregnancy. Children and other family household members should also be up to date with their immunizations; this decreases a pregnant woman's risk of exposure to infections during pregnancy. Vaccine safety during pregnancy is discussed separately. (See "Patient information: Vaccination during pregnancy (Beyond the Basics)".)

Animal borne illnesses — Women 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. Precautions about handling pets and laboratory animals should be discussed with a healthcare provider. (See "Patient information: Animal bites (Beyond the Basics)".)

INFECTIONS

Several infectious diseases can cause problems in pregnancy. Currently, these infections cannot be prevented with a vaccine. These infections are best avoided by practicing good hygiene and avoiding direct contact with infected individuals (although this may be difficult in some cases).

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 women are already immune by the time they become pregnant.

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 an infected person is 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. (See "Parvovirus B19 infection during pregnancy".)

Pregnant women who become infected with parvovirus are monitored closely for signs of complications. Rarely, parvovirus can cause a miscarriage, 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 of mothers who are infected with CMV during pregnancy. The risk of becoming infected with CMV for the first time is higher for pregnant women who live with young children or work in day care centers. (See "Cytomegalovirus infection in pregnancy".)

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/ncidod/diseases/cmv.htm, and include the following:

Practice good personal hygiene throughout pregnancy, especially hand washing with soap and water after touching diapers or saliva (particularly if the child is in day care). Do not share food, drink, or eating utensils. Wash your hands after changing diapers, feeding a young child, wiping a young child’s nose or drool, or handling the toys of a young child.

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

Pregnant women with CMV are not usually treated for the infection. Newborns are not usually treated for CMV unless there are complications. (See "Cytomegalovirus infection and disease in newborns, infants, children and adolescents", section on 'Neonates'.)

There is a low risk of passing CMV infection to a newborn from a mother with recent CMV infection. However, the benefits of breastfeeding outweigh the minimal risk of passing CMV through breast milk. (See "Patient information: 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 woman becomes infected during pregnancy. (See "Toxoplasmosis and pregnancy".)

Pregnant women should avoid eating rare and uncooked meat, which can be a source of this parasite.  House cats can also carry toxoplasmosis in their feces. Pregnant women should have someone else change the litter box or wear gloves and then wash their hands carefully afterwards. It is also important to wear gloves while gardening and to wash 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 birth, or newborn infection. It can be passed from an infected mother to her fetus through the blood. Signs and symptoms of Listeria include fever, chills, and back pain; a nonspecific flu-like illness is the most common symptom. (See "Treatment, prognosis, and prevention of Listeria monocytogenes infection".)

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, women who are pregnant are advised to avoid foods that could contain Listeria (see 'Food precautions' above).

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 readily transmitted. These infections can be serious for both the mother and baby. However, if a nonimmune unimmunized pregnant woman is exposed to an individual with chickenpox, VariZIG, a purified human immune globulin preparation, can be administered as soon as possible within 10 days of exposure and can reduce the risk of developing varicella infection and also attenuate the severity of infection in those who become infected.

Vaccination to protect you from chickenpox or rubella is not safe during pregnancy. (See "Varicella-zoster virus infection in pregnancy" and "Patient information: Chickenpox prevention and treatment (Beyond the Basics)" and "Rubella in pregnancy".)  

Group B streptococcus — Many women normally carry group B streptococcus in their vagina or rectum. Although you will not have symptoms, you can transmit the bacteria to the baby during birth. This can cause a serious newborn infection. For this reason, pregnant women are checked for group B strep a few weeks before expected delivery and given antibiotics during labor if they carry the bacteria. (See "Neonatal group B streptococcal disease: Prevention" and "Patient information: Group B streptococcus and pregnancy (Beyond the Basics)".)

Genital herpes — Women 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. 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 "Genital herpes simplex virus infection and pregnancy" and "Patient information: Genital herpes (Beyond the Basics)".)

Hepatitis — There are several types of hepatitis. Hepatitis infection can be acquired in several ways, including sexually, by transfusion, or during birth. If you or your partner has a history of hepatitis, talk to you doctor about the risk of newborn infection and ways to prevent it. (See "Hepatitis B and pregnancy" and "Vertical transmission of hepatitis C virus".)

HIV — HIV can be passed from a mother to her 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 women to be tested for HIV. (See "Use of antiretroviral medications in pregnant HIV-infected patients and their infants in resource-rich settings".)

TREATMENT OF INFECTIONS DURING PREGNANCY

The safety and availability of treatment for infection in pregnant women depends upon the type of infection and risk of harm (from the treatment or the infection) to the woman and her fetus. Pregnant women and their families are advised to discuss any concerns about infections or treatments with a healthcare 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 information: Vaccines and pregnancy (The Basics)
Patient information: How to plan and prepare for a healthy pregnancy (The Basics)
Patient information: Erythema infectiosum (fifth disease) (The Basics )
Patient information: Malaria (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 information: Food poisoning (food-borne illness) (Beyond the Basics)
Patient information: West Nile virus infection (Beyond the Basics)
Patient information: Genital herpes (Beyond the Basics)
Patient information: Gonorrhea (Beyond the Basics)
Patient information: Chlamydia (Beyond the Basics)
Patient information: Genital warts in women (Beyond the Basics)
Patient information: General travel advice (Beyond the Basics)
Patient information: Vaccination during pregnancy (Beyond the Basics)
Patient information: Animal bites (Beyond the Basics)
Patient information: 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.

Neonatal group B streptococcal disease: Prevention
Clinical manifestations and diagnosis of Listeria monocytogenes infection
Group B streptococcal infection in pregnant women
Group B streptococcus: Virulence factors and pathogenic mechanisms
Immunizations during pregnancy
Intraamniotic infection (chorioamnionitis)
Overview of TORCH infections
Prevention of arthropod and insect bites: Repellents and other measures
Rubella in pregnancy
Toxoplasmosis and pregnancy
Treatment, prognosis, and prevention of Listeria monocytogenes infection
Varicella-zoster virus infection in pregnancy
Parvovirus B19 infection during pregnancy
Cytomegalovirus infection in pregnancy
Cytomegalovirus infection and disease in newborns, infants, children and adolescents

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)

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Literature review current through: Sep 2014. | This topic last updated: Nov 26, 2013.
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