What women need to know about measles and pregnancy
July 2, 2019
In 2000, the government determined that measles had been eliminated in the U.S. But in 2019, we're seeing a resurgence of the disease that is putting pregnant women, babies, and other vulnerable populations across the country at risk.
As of June 13, 2019, more than 1,000 cases of measles have been confirmed in 28 states – up six states from the previous week. Texas has already had more cases in 2019 (15 confirmed to date) than in all of 2018 (nine total).
The rise in measles can be attributed to many factors, including:
- Travel between the U.S. and areas with high measles infection rates.
- Vaccine hesitancy – more than 90 percent of a community must be vaccinated to achieve "herd immunity," or protection for people who medically can't be vaccinated.
- Lack of education about vaccine boosters from providers to patients.
- The highly contagious nature of measles – it can stay in the air for two hours after an infected person leaves an area, and the virus is easily spread through breathing, talking, sneezing, or coughing. Infection requires very little exposure to the virus.
Nine out of 10 people who haven’t had the measles before or haven’t been vaccinated will come down with the illness when exposed. Even those who have been vaccinated can get measles, though symptoms might be less severe.
While measles in pregnant women has not been shown to cause birth defects in the developing fetus, research suggests that exposure to the virus can increase the risk of miscarriage and preterm birth. However, the measles vaccine is given as part of the measles, mumps, and rubella (MMR) vaccination and cannot be given during pregnancy.
The recent increase in confirmed cases of measles has led the American Congress of Obstetricians and Gynecologists (ACOG) and researchers from the University of Washington to update measles prevention guidelines for pregnant and reproductive-aged women at high risk of infection.
| Measles cases reported by year | U.S. | Primary outbreak state |
|---|---|---|
| 2014 | 667 | 338 cases in Ohio |
| 2015 | 188 | 147, California |
| 2016 | 86 | (no outbreaks) |
| 2017 | 120 | 75, Minnesota |
| 2018 | 372 | 82, New York |
| 2019 (as of June 27) | 1,095 | 275, New York |
| Source: CDC |
Women's health updates for measles risk
The revised guidelines include three main considerations for women:
If you are considering pregnancy, this is the perfect time to check your immunization record.
- If you are at average risk and have received one dose of the measles, mumps, and rubella (MMR) vaccine, you've done all you can to protect yourself.
- If you are at high risk, you should have two MMR vaccinations. The University of Washington is recommending this approach for certain individuals, including healthcare workers, college students, and international travelers.
- If you can’t locate your records and are uncertain, the IgG ELISA blood test can help determine whether you received the measles vaccine or had measles as a child.
- For about four weeks after receiving an MMR vaccine, take additional precautions to avoid pregnancy.
If you are pregnant and you are exposed to measles, contact your doctor right away. You might be able to receive a treatment to reduce the likelihood of infection.
After pregnancy, consider getting an MMR vaccine if you aren’t immune. It is safe for breastfeeding women and babies.
Even if you have no desire to become pregnant, getting an MMR vaccine can help protect your health and the health of others in the community who are at risk for infection, including pregnant women, infants, and people with weakened immune systems.
Related reading: Beyond healthy babies: Why we discuss vaccines, maternal health during pregnancy
A few closing thoughts
Patients with measles are considered contagious as early as four days prior to breaking out with the signature measles rash. Early symptoms include fever, cough, and general weakness and fatigue. A red, bumpy rash follows, typically after 14 days of exposure.
We recommend that patients consider vaccination for themselves before pregnancy and discuss vaccination with family members and friends who will be around the baby.
The health of women and babies is our utmost concern. If you're concerned that you've been exposed, call your doctor right away. If you aren't sure about your vaccination history or know that you need the MMR vaccine, call 214-645-8300 or request an appointment online.
