Measles during pregnancy related to adverse outcomes

Infection with measles during pregnancy increased the risk for adverse maternal, fetal and neonatal outcomes in Namibia, researchers from the CDC reported.

“Maximizing measles immunity in women of childbearing age would decrease the incidence of gestational measles and the attendant maternal, fetal and neonatal morbidity and mortality,” they wrote in Clinical Infectious Diseases. “With a measles elimination goal by 2020 set in 2011 for the WHO African Region, interventions that address the special circumstances of this vulnerable population are needed to reduce the morbidity and mortality from this deadly infection.”

According to the researchers, a measles outbreak in Namibia from Aug. 2, 2009, to Feb. 2, 2011, resulted in 4,605 reported cases of measles, of which 38% occurred in adults. The study included a cohort of 55 pregnant women who were diagnosed with measles during a 12-month time frame in this outbreak. All of these women were matched with three pregnant women without measles. The researchers reviewed clinical records and conducted interviews to evaluate the pregnancy outcomes.

Thirty-nine of the 55 women with measles experienced measles-related complications, including diarrhea (n=33), pneumonia (n=22) and encephalitis (n=3). Forty-two of the 55 women had known fetal or neonatal status, and among those, 25 had at least one fetal or neonatal outcome: seven had a spontaneous abortion, four had intra-uterine fetal death and nine had a premature delivery. Five of the women died.

There were 31 live births among the 55 women: 22 were full term, nine were preterm and six were hospitalized in a neonatal ICU. Three of the hospitalized neonates died within 28 days of birth, for a mortality of 10% among the 31 live births. Among the 18 neonates with known birth weight, seven had a low birth weight. None of the infants born to pregnant women with measles had congenital anomalies.

In an accompanying editorial, Philip Brunell, MD, said there has been a “disquieting increase” in measles among adults, partially because of suboptimal immunization in some areas that leave adults susceptible to measles.

“The global measles eradication program has been remarkably successful in decreasing mortality in children from this disease,” Brunell wrote. “We should not, however, neglect the plight of adults and, particularly, pregnant women, as they appear to constitute an increasing proportion of the cases in places with incomplete protection of the population.”

For more information:

Brunell P. Clin Infect Dis. 2014;doi:10.1093/cid/ciu041.

Ogbuanu I. Clin Infect Dis. 2014;doi:10.1092/cid/ciu037.

Disclosure: Brunell and the study researchers report no relevant disclosures.