What to expect when you're expecting (195 page)

There is little risk to an expectant mother from toxoplasmosis, and the risk of a fetus becoming infected if mom has contracted the infection and is untreated is only about 15 percent. The earlier in pregnancy a mother is infected, the less likely the illness will be transmitted to her baby but the more serious the consequences will be. The later in the pregnancy, the greater the transmission rate but the less severe the potential consequences. Fortunately, the number of pregnant women who contract toxoplasmosis is small to begin with, and only 1 in 10,000 babies is born with severe congenital toxoplasmosis.

Recent advances have made it possible to test fetal blood and/or amniotic fluid and the fetus’s liver via ultrasound to learn whether or not the fetus has actually become infected, though not usually before 20 to 22 weeks. If no infection is detected, the fetus is most likely fine.

The best “treatment” of toxoplasmosis, however, is prevention. See
page 79
for tips on how to avoid infection.

“My son came home from preschool with a note saying that there’s an outbreak of CMV at his school. Is this something I should worry about catching during pregnancy?”

Luckily, the chances of picking up cytomegalovirus (CMV) from your son and passing it on to your baby are remote. Why’s that? A majority of adults were infected in childhood, and if you’re among that majority, you can’t “catch” CMV now (though it could become “reactivated”). Even if you did come down with a new CMV infection during pregnancy, the risks to your baby are low. Though half of infected moms give birth to infected infants, only a tiny percentage of them ever show any ill effects. The risks are lower still in a baby whose mom had a reactivated infection during pregnancy.

Still, unless you know for sure that you’re immune to CMV because you had the infection before, your best defense is a good offense. Take preventative measures such as washing up carefully after changing your son’s diapers or helping him out at the potty, and resist nibbling on your preschooler’s leftovers. (And if you work in a child-care or preschool setting, always practice good hygiene protocol.)

Though CMV often comes and goes without any obvious symptoms, it’s occasionally marked by fever, fatigue, swollen glands, and sore throat. If you notice any of these symptoms, check with your doctor. Whether these symptoms signal CMV or another illness (such as flu or strep throat), you’ll need some sort of treatment.

“I was told that a disease I had never even heard of before—fifth disease—could cause problems in pregnancy.”

Fifth disease is the fifth of a group of six diseases that cause fever and rash in children. But unlike its sister diseases (such as measles and chicken pox, the ones that get all the attention), fifth disease isn’t widely known because its symptoms are mild and can go unnoticed—or may even be totally absent. Fever is present in only 15 to 30 percent of cases. For the first few days, the rash gives the cheeks the appearance of having been slapped, then spreads in a lacy pattern to trunk, buttocks, and thighs, recurring on and off (usually in response to heat from the sun or a warm bath) for one to three weeks. It is often confused with the rash of rubella and other childhood illnesses or even a sun- or windburn.

Concentrated exposure from caring for a child sick with fifth disease or from teaching at a school where it is epidemic somewhat increases that very small risk of contracting the illness. But half of all women of childbearing age had fifth disease during childhood and are already immune, so infection, happily, isn’t common among pregnant women. In the unlikely event that a mom catches fifth disease and her fetus does become infected, the virus can disrupt the developing baby’s ability to produce red blood cells, leading to a form of anemia or other complications. If you do contract fifth disease, your practitioner will follow you for signs of fetal anemia with weekly ultrasounds for eight to ten weeks. If the baby is infected during the first half of pregnancy, the risk of miscarriage increases.

Again, the odds that fifth disease will affect you, your pregnancy, or your baby are very remote. Still, as always, it makes sense to take the appropriate steps to avoid any infection while you’re expecting (see opposite page).

“I can’t remember if I was vaccinated against measles when I was a child. Should I be immunized now?”

No. Measles vaccine (a component of the MMR vaccine) isn’t given during pregnancy because of the theoretical risk to the fetus from the vaccine, though there have been no reports of problems among newborns whose mothers were inadvertently vaccinated. Besides, the chances are good that you are already immune to measles, since most women of childbearing age either had the disease or were vaccinated against it as children. If your medical history doesn’t include this information and your parents can’t recall it, your doctor can run a test to determine whether you are immune. Even if you’re not immune, the risk that you might contract measles is extremely remote because the disease has been practically wiped out in the United States (which means it would be highly unlikely that you’d be able to catch it here).

In the exceedingly unlikely event that you are exposed directly to someone with measles and are not immune, your doctor may administer gamma globulin (antibodies) during the incubation period—between exposure and the start of symptoms—to decrease the severity of the illness should you come down with it. Measles, unlike rubella, does not appear to cause birth defects, though it may be linked to an increased risk of miscarriage or premature labor. If you were to contract measles near your due date, there is a risk that your newborn might catch the infection from you. Again, gamma globulin may be administered to reduce the severity of such an infection. Keep in mind that all this is pretty much theoretical, given how rare measles are these days.

“A coworker of mine came down with a bad case of the mumps. Should I get immunized so I don’t get it myself?”

It’s not that easy to get mumps these days—in fact, it’s pretty close to impossible. Fewer than 250 Americans contract mumps each year, thanks to routine childhood immunization with MMR (measles, mumps, rubella). And chances are you were vaccinated, too, when you were a child (or, less likely, that you actually had the disease), which means you can’t catch it now. If you’re not sure whether you were immunized against or had mumps, check with your parents or the doctor who cared for you as a child, if that’s possible.

If it turns out you’re not immune, you can’t be immunized now because the vaccine might be harmful to your fetus. Even without immunity, though, the risk of contracting mumps is very low. It isn’t highly contagious through casual contact. However, because the disease appears to trigger uterine contractions and is associated with an increased risk of miscarriage in the first trimester or preterm labor later, be alert for the first symptoms of the disease (possibly vague pain, fever, and loss of appetite before the salivary glands become swollen; then ear pain and pain on chewing or on taking acidic or sour food or drink). Notify your practitioner of such symptoms immediately because prompt treatment can reduce the chance of problems developing. You might also want to consider the MMR vaccine before deciding to get pregnant again, just to be on the safe side.

Staying Well

In pregnancy, when you need to stay well for two, the proverbial ounce of prevention is worth far more than a pound of cure. The following suggestions will increase your chances of staying well when you’re expecting (and when you’re not):

Keep your resistance up.
Eat the best diet possible, get enough sleep and exercise, and don’t run yourself down by running yourself ragged. Reducing stress in your life as much as you can also helps keep your immune system in tip-top shape.

Avoid sick people like the plague.
As best as you can, try to stay away from anyone who has a cold, flu, stomach virus, or anything else noticeably contagious. Keep your distance from coughers on the bus, avoid lunching with a colleague who’s complaining of a sore throat, and evade the handshake of a friend with a runny nose (germs as well as greetings can be exchanged in a handshake). Also avoid crowded or cramped indoor spaces when you can.

Wash your hands.
Hands are the major spreader of infections, so wash them often and thoroughly with soap and warm water (about 20 seconds does the trick), particularly after exposure to someone you know is sick and after spending time in public places or riding on public transportation. Hand washing is especially important before eating. Keep a hand sanitizer in your glove compartment, in your desk drawer, and in your handbag or briefcase so you can wash up when there’s no sink in sight.

Don’t share the germs.
At home, try to limit germ-spreading contact with sick children or a sick spouse as much as possible. Avoiding finishing up their sandwich scraps and drinking from their cups. And while every sick child needs a dose of kiss-and-hug therapy from mom now and then, be sure to wash your hands and face after those comforting cuddles. Wash your hands, too, after touching their germy sheets, towels, and used tissues, especially before touching your own eyes, nose, and mouth. See that the little patients wash their hands frequently, too, and try to get them to cough and sneeze into their elbows instead of their hands (a good tip for adults, too). Use disinfectant spray or wipes on telephones, computer keyboards, remotes, and other surfaces they handle.

If your own child or a child you regularly spend time with develops a rash of any kind, avoid close contact and call your doctor as soon as you can unless you already know that you are immune to chicken pox, fifth disease, and CMV.

Be pet smart.
Keep pets in good health, updating their immunizations as necessary. If you have a cat, take the precautions to avoid toxoplasmosis (
page 79
).

Look out for Lyme.
Avoid outdoor areas where Lyme disease is prevalent, or be sure to protect yourself adequately (see
page 507
).

To each his or her own.
Maintain a no-sharing policy when it comes to toothbrushes and other personal items (and don’t let those toothbrushes mingle bristle-to-bristle). Use disposable cups for rinsing in the bathroom.

Eat safe.
To avoid food-borne illnesses, practice safe food preparation and storage habits (see
page 116
).

“I might have been exposed to rubella on a trip out of the country. Should I be worried?”

Happily, the vast majority of pregnant women in the United States are immune to rubella (German measles), either because they were immunized against it as a child (it’s the “R” in the MMR vaccine) or contracted it at some other time in their lives (usually during childhood). In fact, the CDC considers rubella to be eradicated here, so the odds are good that you can’t catch it and, consequently, have nothing to worry about. If you’re not sure whether or not you are immune (around 25 percent of women may not be immune because they were born outside the United States), you can find out with a simple test—a rubella antibody titer—that measures the level of antibodies to the virus in your blood and is performed routinely at the first prenatal visit by most practitioners. If this test was not performed earlier, it should be now.

In the unlikely event you turn out not to be immune (or if the antibody levels in your blood are low), you still don’t have to consider drastic measures immediately. For the virus to do its damage, you have to actually come down with the illness. The symptoms, which show up two or three weeks after exposure, are usually mild (malaise, slight fever, and swollen glands, followed by a slight rash a day or two later) and may sometimes pass unnoticed. If you did come down with rubella during pregnancy (and, again, the odds are extremely remote), whether your baby would be at risk would depend on when you contracted it. During the first month, the chance of a baby developing a serious birth defect from in utero exposure is pretty high. By the third month, the risk is significantly lower. After that, the risk is lower still.

There is no way of absolutely preventing an exposed woman with no immunity from coming down with rubella—but because the chance of being exposed to rubella in the United States is almost nil, that scenario is just about never encountered. Still, if you aren’t immune and don’t contract the disease this time around, avoid the concern entirely in subsequent pregnancies by being vaccinated after this delivery. As a precaution, you will be advised not to become pregnant for one month following vaccination. But should you conceive accidentally during this time, or if you were vaccinated early in this pregnancy, before you knew you had conceived, don’t worry. Apparently, there is no risk when an expectant woman is inadvertently vaccinated early in pregnancy or if she conceives soon after vaccination.

“My toddler was exposed to chicken pox at her child-care center—by a child who wasn’t immunized. If she comes down with it, could the baby I’m now carrying be hurt?”

Not likely. Well insulated from the rest of the world, a fetus can’t catch chicken pox from a third party—only from its mother. Which means you would have to catch it first, something that’s unlikely. First of all, your child probably won’t catch it and bring it home if she was immunized with the varicella vaccine. Second of all, it’s very likely you had the infection as a child (85 to 95 percent of the U.S. adult population has had it) and are already immune. Ask your parents or check your health records to find out whether you have had chicken pox. If you can’t find out for sure, ask your practitioner to run a test now to see if you are immune.