When you’re pregnant and catch measles

A cough is one of the symptoms of measles, which also include a running nose, red and watery eyes, small white spots inside the cheeks (Koplik spots), and a rash that occurs on the face and upper neck, then spreads to the hands and feet. — Positive Parenting

Measles is one of the most contagious diseases in the world; so much so that many public health specialists term it “the canary in the coal mine”.

It is caused by a virus that infects the respiratory tract and then spreads throughout the body, leading to severe disease, complications and death.

Measles spreads following contact with infected nasal or throat secretions (from cough or sneezing), or by breathing air from someone with measles.

The virus remains active and contagious in the air or on infected surfaces for up to two hours.

As such, it is very infectious, and anyone infected can spread the infection to 12 to 18 susceptible individuals.

This is about twice as infectious as chicken pox and several times more than Covid-19 and influenza.

There has been a global resurgence of measles.

The dramatic increase in the United States has been a common media topic.

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There are similar increases across Europe, Cambodia, Laos, Malaysia, the Philippines and Vietnam.

The number of cases in Malaysia has, to date, exceeded the total number in 2024.

Symptoms and complications

Following exposure to the measles virus, symptoms that can manifest include a cough, running nose, red and watery eyes, and small white spots inside the cheeks.

A prominent feature of measles is a rash that occurs about one to two weeks after exposure to the virus.

The rash is usually found on the face and upper neck, and then spreads to the hands and feet.

It usually fades away after five to six days.

A person can spread measles starting from four days prior to the onset of the rash to four days after the rash erupts.

The complications of measles include severe diarrhoea and dehydration, ear infection, breathing difficulties including pneumonia, blindness, and encephalitis (infection of the brain that can damage it).

The complications are more common in:

• Children under five years of age
• Malnourished children, especially those who are vitamin A deficient or with poor immunity due to HIV (human immunodeficiency virus) and other diseases
• Adults over 30 years of age, and
• Pregnant women.

Measles by itself also weakens the body’s immune system and can cause the body to “forget” how to respond against other infections.

This leads to increased vulnerability in affected children and the pregnant.

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Increased risk in pregnancy

Measles can affect anyone, but it is most common in children.

Pregnant women with measles are at increased risk of its complications, which include pneumonia, hepatitis, and hospitalisation with a 10-fold higher risk of death compared to the non-pregnant.

The risks of miscarriage, intrauterine growth restriction and preterm birth are also increased.

If there is maternal infection a fortnight prior to childbirth, congenital measles can occur.

The infection usually manifests in the newborn within the first 10 days of life, with symptoms like fever, rash, hepatitis and pneumonia.

Such infection can have serious acute and long-term complications that include encephalitis and death.

Managing measles in the pregnant

There is no cure for measles.

The management is supportive and includes the treatment of complications.

Whenever a pregnant patient has measles, medical attention should be sought from an infectious disease specialist.

When there are concerns about maternal complications, admission to a hospital with an appropriate level of maternal and neonatal care would be necessary.

Strict infection control measures are mandatory during the infectious period and for newborns with exposure or infection.

The duration of isolation will be determined by the infectious disease specialist and their team.

A dose of intravenous immunoglobulin (IVIG) is recommended up to six days after exposure to susceptible pregnant women who have not had previous measles infection and have not been vaccinated.

Those who have had one previous dose of measles vaccine or whose vaccination status is unknown may also be susceptible.

If their immunoglobulin G test is negative or available, IVIG is also recommended.

Preterm labour is considered a potential indicator of infection in an exposed, susceptible pregnant patient.

When administered to the newborn, IVIG may prevent infection or decrease the likelihood of complications.

A preventable outbreak

The global resurgence of measles is a wake-up call for the public, as well as healthcare providers.

The deaths that have occurred were preventable.

A very effective measles vaccine has been commercially available since 1963, i.e. for more than six decades.

Global vaccination against measles has been estimated to have saved more than 94 million lives in the past 50 years – more than all vaccine-preventable diseases combined except for smallpox.

Yet there are many who believe that measles is harmless and that vaccinations are more harmful, citing autism as a potential side effect – a claim that has been debunked by numerous studies.

Other obsolete beliefs include the endorsement of measles parties (which aim to spread the infection intentionally), and the use of vitamin A, budesonide and clarithromycin as treatments.

Vaccination rates declined in many countries after the Covid-19 pandemic, leading to marked increase in measles cases in 2023 and 2024.

Malaysia was no exception.

We have had a measles elimination programme since 2004 and made a commitment to eliminate measles by 2023.

However, the number of confirmed cases in 2023 was 1,968, and 3,456 in 2024 – a 76% increase.

Despite the known complications and availability of effective vaccines, measles continues to pose a significant global health threat.

The increased risk for further measles outbreaks can be addressed with concerted efforts to restore vaccination rates to pre-pandemic levels, and to allay the concerns of vaccine sceptics.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.