Why is rubella dangerous when pregnant? | Health Magazine

A mild childhood disease, rubella is particularly serious for the fetus when a pregnant woman is infected during the first months of pregnancy. What are the risks ? How to guard against it? The answers to our questions with Dr. Christelle Vauloup-Fellous, virologist and coordinator of the National Rubella Reference Center.

What is rubella?

A contagious viral infection caused by rubivirus, an RNA virus from the Togaviridae family, rubella is a mild disease in children and adults . On the other hand, it is particularly serious when contracted during pregnancy. “The consequences can be very serious for the unborn child, especially during the first months of pregnancy, confirms Dr. Christelle Vauloup-Fellous. Congenital malformative rubella syndrome is characterized by neurological, cardiac, ocular and auditory damage.

Epidemiology of rubella

Fortunately, thanks to vaccination, rubella has declined significantly worldwide. “As of December 2018, 168 out of 194 countries had introduced the rubella vaccine, says the World Health Organization. Reported rubella cases fell by 97%, from 670,894 cases in 102 countries in 2000 to 14,621 cases in 151 countries in 2018.” In France, as in most European countries as well as in North and South America, autochthonous malformative congenital rubella has been eliminated.

"However, we are regularly confronted with imported cases, and more problematically with secondary cases in the population - that is to say rubella in people who have not traveled - due to vaccination coverage imperfect in certain French regions, adds the virologist. The WHO currently estimates the number of malformative congenital rubella at 100,000 cases per year, mainly in Africa and South-East Asia where vaccination coverage is lowest”.

How is it transmitted?

The rubella virus is transmitted through droplets of saliva from the airways (cough or sneeze) in the event of close contact with a infected person.

What are the symptoms?

Why is rubella dangerous when are you pregnant? | Santé Magazine

In one out of two cases, i.e. 50% of cases, the viral infection is completely asymptomatic. When she is symptomatic, the manifestations appear about two weeks after the contamination. Rubella then results in:

Screening: how do you know if you are immune to rubella?

Serological screening is carried out at the start of pregnancy to find out if you are immune to the virus. This is done from a simple blood test. This serology, called rubella serology, makes it possible to check that you are protected (previous infection by the virus or vaccination). "Screening is recommended at the first prenatal consultation for women who are unable to prove their immunity," explains the specialist. That is to say those who cannot provide proof of complete vaccination or a previous serological result proving that they are immunized”.

If the result of the IgG antibody test is positive in early pregnancy, whatever the rate, you will be considered to be immune (protected). Today, about 95% of pregnant women in France are immunized, most often thanks to vaccination.

What should you do if you are not immune?

Apart from pregnancy, if you are not immune to the virus, it is very strongly recommended to get vaccinated. “As the vaccine is contraindicated in pregnant women, additional screening will be offered in the middle of pregnancy to ensure that the patient has not been infected with the virus, explains the virologist. She will also be advised to be vaccinated immediately after delivery at the maternity ward. Vaccination does not contraindicate breastfeeding.

Finally, rest assured, if the vaccination was carried out inadvertently during pregnancy, cases of transmission of the virus to the fetus are rare (5%) and there is no risk of malformation.

What are the risks for pregnancy?

If you are not immune, you are not protected against the virus and neither is your baby. In case of contamination, the infectious agent can reach the fetus: this is called congenital rubella which can be malformative.

“If a pregnant woman contracts the virus early in her pregnancy, the risk of transmission is greatest (more than 90%) and the consequences for the baby are usually serious. At this stage, infection with the rubella virus can cause miscarriage, psychomotor retardation which can be very significant, and/or malformations that can affect the eye (cataract), the heart (cardiopathy), and the inner ear (deafness). On the other hand, in the second half of pregnancy, the transplacental passage of the virus is still possible but the infected children will not present sequelae of the congenital infection”.

How to avoid rubella during pregnancy?

The rubella vaccine

The only way to protect yourself against the virus is to get vaccinated. “Everyone must have received two doses of MMR (measles/mumps/rubella) vaccines in their lifetime, regardless of the time between doses if it is at least one month, specifies Dr. Christelle Vauloup-Fellous. Pregnant women are rather well covered since seroprevalence is estimated at more than 95% in this population. A particular effort remains to be made in men where in certain age categories up to 15% are not immunized and also in children born before 2018”. Remember that the rubella vaccine is now mandatory for all children born from January 1, 2018.

What to do in case of contamination?

If you are contaminated, biological confirmation will be requested and a declaration made to Public Health France. Rubella is, in fact, a notifiable disease. “In the event of contamination in the first half of pregnancy, ultrasound monitoring and amniocentesis are offered to the mother-to-be, specifies Dr. Christelle Vauloup-Fellous. If the fetal infection is proven at an early term and the parents request it, an abortion can be accepted given the poor prognosis of these congenital infections”. If the baby is infected, close monitoring by a reference center will be put in place to verify the absence of malformation by regular ultrasounds. “On the other hand, continues the specialist, in the event of maternal contamination in the second half of pregnancy, even if the fetus is very often infected, the risk of malformative congenital rubella is nil and no particular follow-up will be offered apart from a diagnosis at birth at aim of prevention of the people of the entourage. In fact, even asymptomatic infected children are very contagious for many months. It is therefore necessary to ensure the vaccination status of those around you”.

Each year, in France, less than five women contract rubella during their pregnancy.

World Health Organization

Public Health France

High Authority for Health

Read alsoAuthor: Sophie Helouard, health journalistExpert: Dr. Christelle Vauloup-Fellous, virologist and coordinator of the National Rubella Reference Center Article published on

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