Complications in Fetus During Pregnancy

Our further treatment of the Causes of Cerebral Palsy is broken out into the following categories:

• Factors or Complications in the Mother During Pregnancy (covered below on this page);
• Complications in the Fetus During Pregnancy; and
• Problems during Delivery.

Factors or Complications in Pregnant Mother During Pregnacy

1. Maternal infectious diseases:

These diseases have the greatest negative effect upon the fetus during the first 6 months because this is when nervous system is still developing in the fetus.

• Rubella German/Measles: Rubella, once known as German measles or the sometimes called the 3-day measles, is a contagious respiratory disease caused by the rubella virus and best known by its characteristic red rash.

Symptoms generally appear between two and three weeks after exposure to the virus. While many people with rubella have few or no symptoms, symptoms can include:

• Mild fever of 102° F or lower, usually 99 to 100° F, that lasts 1-2 days
• A fine rash of pink or light red spots (thus, the Latin word “rubella” which means “little red”) that begins on the face, spreads downward to the trunk, then the arms and legs, and disappears in the same pattern. The rash may itch and lasts up to 3 days.
• Headache & swollen, aching joints (more common in teens and adults)
• Stuffy or runny nose
• Inflamed, red eyelids and eyes
• Swollen, tender lymph nodes, usually in the back of the neck or behind the ears
• Loss of appetite

Children usually are vaccinated with the measles-mumps-rubella (MMR) vaccine before going to school. They receive their 1st vaccination at 12 – 15 months of age, and a second does at 4 – 6 years of age. Rubella has been virtually eliminated in the United States because of the widespread use of the vaccine. Continued vaccinations, however, are important in preventing its re-emergence.

Rubella is a relatively mild disease with minimal effects if infected during childhood. The most serious effects of Rubella happen when a pregnant woman becomes infected within the first 5 months of pregnancy. If the fetus survives since 20% of these pregnancies end in miscarriage, the baby may be born with congenital rubella syndrome (CRS) which puts them at risk for growth and/or mental retardation, defects of the heart and eyes, deafness, liver and spleen damage, and bone marrow problems. Babies born with CRS can carry the virus a few months after birth, and are thus, a potential source of infection for other infants or pregnant women.

If a woman becomes pregnant is either is not sure about her vaccination record or if she has already had the disease, a blood test can be done to check for immunity against rubella (i.e., the likelihood of developing rubella if exposed to the virus). If a woman is contemplating becoming pregnant, it is better to check these things before doing so and receiving the vaccine against rubella if necessary.

• Chickenpox/Varicella: a very contagious, common illness among kids characterized by an itchy rash of spots that look like blisters which can appear all over the body and is often accompanied by flu-like symptoms. Symptoms include:

• a red, itchy rash which looks like pimples or insect bites; the rash usually appears first on the stomach or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals. These bumps turn into blisters less than a quarter of an inch wide and are filled with fluid. The blisters break open and then crust over becoming dry, brown scabs.
• a fever of about 100 to 102° F (higher in rare cases)
• headache
• abdominal pain
• loss of appetite
• sore throat
• dry cough

It is recommended that children be immunized against chickenpox between 12 to 15 months of age, with a follow-up booster shot at 4 to 6 years of age. People 13 years of age and older who have never had chickenpox or have not been vaccinated against chickenpox vaccine should get two doses of the vaccine at least 28 days apart.

Potential risks to the child depends on when the mother became infected with chickenpox. If a woman contracts it within the first 5 months of pregnancy, she is at risk for miscarriage or premature labor and her baby will be at risk for low birth weight, birth defects (such as limb abnormalities or eye problems), seizures after birth, or mental retardation. If a she develops chickenpox during the last half of her pregnancy, she is at risk for acquiring varicella pneumonia and potentially dying. If she contracts chickenpox the week before delivery or soon after the child’s birth, the baby is at risk for serious complications if not treated (i.e., encephalitis, pneumonia, Reye’s syndrome, cerebellar ataxia). Pregnant women who are exposed to chickenpox can receive an injection which may prevent chickenpox or reduce its severity.

Women who have not had chickenpox or have not been immunized against rubella, should do so before becoming pregnant. A blood test can be done to check for immunity (i.e., the likelihood of developing chickenpox if exposed to the virus) if in doubt.

• Cytomegalovirus (CMV): CMV is a member of the herpes virus family, which includes the herpes simplex viruses and the viruses that cause chickenpox (varicella-zoster virus) and infectious mononucleosis (Epstein-Barr Virus). CMV is a very common virus infecting people of all ages. According to the Centers for Disease Control and Prevention (CDC), somewhere between 50 to 85% of people in the U.S. have had this virus by the time they are 40. Because symptoms are so much like other illnesses (e.g., sore throat, fever, swollen glands, fatigue), most people do not know whether or not they have had CMV.

CMV rarely causes serious complications in healthy individuals who become infected. This is not the case, however, for women who contract CMV for the first time while they are pregnant. Even though the mother may experience a mild illness without consequence, a developing fetus and young infant are at risk for developing significant problems. Babies who have symptoms of CMV at birth which get worse, are at greater risk of developing permanent disabilities such as vision or hearing impairments, cognitive deficiencies, or neurological problems such as seizures and lack of coordination. In some cases these problems may not occur until months or years after birth.

• Toxoplasmosis: Caused from a protozoan parasite found in undercooked contaminated meats and in the feces of cats who spend time outside and become infected by eating other animals infected with this parasite.

This parasite can be completely unnoticed by an infected mother and be transmitted to her unborn child, causing miscarriage or stillborn birth, or brain inflammation and diseases of the nervous system and eyes. The baby may be born with visible signs of toxoplasmosis (i.e., an abnormally large or small head), or may not show any signs at birth and later develop vision loss, mental disability and seizures.

Pregnant woman can minimize the possibility of getting toxoplasmosis by avoiding coming into contact with cat feces (i.e, litter boxes or contaminated soil), not eating uncooked meat, and washing hands after touching anything that may have come into contact with cat feces or uncooked meat.

• Syphilis: a sexually transmitted disease which can be transmitted from mother to baby either through the plancenta during pregnancy or through direct contact with a sore during birth. Left untreated, syphilis can lead to serious problems; syphilis increases the risk for miscarriage, stillbirth, death of baby, preterm birth or intrauterine growth restriction. Problems related to the development of syphilis in the fetus early in the pregnancy can been seen on an ultrasound (i.e., overly large plancenta, fluid in the abdomen, enlarged liver or spleen). Some babies show symptoms of syphilis at birth - a skin rash, lesions around the mouth or genitals, pneumonia, unusual nasal secretions, swollen lymph glands, and anemia, while others develop symptoms within the first two months of birth. Babies with syphilis who go untreated may develop vision and hearing impairments, bone and teeth abnormalities, or severe neurological conditions. Women infected with syphilis are more likely to develop HIV if exposed to the virus. Because of the serious consequences and the fact that syphilis has been on the rise in the US, the CDC recommends that all woman be tested for syphilis at the first prenatal visit.

• HIV: is the human immunodeficiency virus that causes AIDS (acquired immune deficiency syndrome). A person’s ability to fight infections is gradually destroyed by HIV. Once a person is diagnosed with AIDS, she is at risk of developing an opportunistic infection (a disease which usually does not cause serious problems in a healthy person, but is life-threatening to a person with a weak immune system). HIV can be transmitted from mother to baby during pregnancy, birth or breastfeeding. Treatment of the virus lowers a baby’s chance of becoming infected from about 25% without treatment to less than 2%. Pregnant women who are HIV-positive are at risk for premature birth, stillbirth and intrauterine growth restriction. While HIV is a potential risk factor for a baby to later develop cerebral palsy, mental retardation is a more common outcome.

For HIV During Pregnancy, Labor and Delivery, and After Birth, go to:
http://aidsinfo.nih.gov/ContentFiles/Perinatal_FS_en.pdf

• Genital herpes simplex: also known as Herpes simplex virus 2 (HSV-2). Although some people have no symptoms, others with this virus have genital ulcers or sores. HSV-2 is usually sexually transmitted, however, cross-infection of HSV-1 and HSV-2 can occur. This means that genital herpes can appear on the mouth, and oral herpes can appear on the genital area.

It is possible for a fetus to become infected with HSV which can cause abnormalities. The HSV virus can be transmitted to a newborn during vaginal delivery from an infected mother. Women do not have to have active infections to transmit the virus to their child. For women with active HSV infections at time of delivery, a cesarean section is recommended to decrease the newborn’s risk of infection.

The frontal and temporal lobes of the brain are usually affected with encephalitis caused by the herpes virus. This may result in learning disabilities and problems with fine motor control or speech.

2. Fever during Pregnancy:

A temperature above 100.4 F, is an indication that something is wrong. It could indicate an infection of the amniotic fluid, amniotic sac, placenta, or urinary track, which could place the fetus at risk for brain damage. Maternal pelvic inflammatory diseases increase the risk of fetal stroke. Fetal stroke suffered by babies in the womb due to placental blood clots and bleeding inside the brain due to a blockage of blood vessels (intracranial hemorrhage). Because invasive testing of natal environments for infection can result in other complications of infection, it is necessary to weigh the risks from the testing vs. the risks of not testing. Maternal infections that could cause a fever and potentially harm a developing fetus are:

• Bacterial vaginosis — a vaginal condition which results from an overgrowth of normal bacteria in the. Symptoms can include a vaginal drainage and foul odor, however, many women actually have no symptoms at all. Although doctors don’t know what causes this condition, factors such as multiple or new sexual partners, douching and smoking increase the chances of developing it.

Bacterial vaginosis is not dangerous, however, in pregnancy it can cause babies to be born prematurely or with a low birth weight and can cause infection of the amniotic fluid or of the uterus after delivery. While bacterial vaginosis is treatable with antibiotics, most studies show that treatment of this condition in pregnant women who do not have any symptoms does not decrease the incidence of premature births.

• Chorioamnionitis — an inflammation/infection of the outer (chorion) and inner (amnion) fetal membranes. The chorion, or outer membrane, is closest to the mother, and the amnion, or inner membrane, surrounds the fetus and is in contact with the amniotic fluid. This is a bacterial infection that typically orginates in the vagina and progresses to the uterus. Premature birth and fetal membranes which have been ruptured for a long period of time can predispose a mother for this infection. The risk for the baby is that this can result in a localized infection in the baby such as meningitis or bacterial pneumonia, or in a systemic infection such as sepsis. A uterine infection causes a baby to be 4 time more likely to develop cerebral palsy. Chorioamnionitis occurs in approximately 2% of U.S. births.

• Sepsis — An infection in the blood stream caused by a bacterial infection. Urinary tract infections are very common during pregnancy and very often are present without any symptoms. Untreated, these infections can progress to sepsis. Although sepsis infections are uncommon, they are potentially fatal to the fetus and/or the mother when they do occur.

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