What is the treatment for rubella (German measles) in a pregnant woman?

Treatment of Rubella in Pregnancy

There is no specific treatment or cure for rubella infection during pregnancy—management is entirely supportive and focused on monitoring for complications.

No antiviral therapy, immune globulin, or other interventions can prevent or treat rubella infection once a pregnant woman is infected. 1 The focus shifts entirely to supportive care for maternal symptoms and careful monitoring for fetal complications.

Supportive Care for the Mother

• Symptomatic treatment only: Manage fever, rash, and joint pain with acetaminophen and rest 2
• Monitor for rare maternal complications including thrombocytopenia (1 per 3,000 cases) and encephalitis (1 per 6,000 cases), which are more common in adults 3
• Joint symptoms (arthralgia/arthritis) occur in up to 70% of infected adult women and typically resolve spontaneously, though they may persist for 1 day to 3 weeks 3

Critical Point About Immune Globulin

Immune globulin (IG) is NOT recommended and should NOT be given for rubella exposure or infection in pregnancy. 1 This is a common pitfall:

• IG will not prevent infection or viremia 1
• IG may only modify or suppress symptoms, creating a false sense of security 1
• IG has not been proven effective in preventing congenital rubella syndrome 1

Fetal Monitoring and Counseling

The devastating impact on the fetus depends critically on gestational age at infection:

• First 8 weeks: Up to 85% risk of congenital defects when followed for 4 years 3, 4
• 9-12 weeks: Approximately 52% risk of defects 3
• 13-16 weeks: Risk declines to 10-24% 3
• After 20 weeks: Defects rarely occur, though fetal infection without clinical signs can still happen 3

Congenital Rubella Syndrome Manifestations

The classic triad and associated findings include 3, 2:

• Auditory: Sensorineural deafness (most common)
• Cardiac: Patent ductus arteriosus, pulmonary artery stenosis, septal defects
• Ophthalmic: Cataracts, microphthalmia, glaucoma, chorioretinitis
• Neurologic: Microcephaly, meningoencephalitis, mental retardation
• Other: Intrauterine growth retardation, hepatosplenomegaly, thrombocytopenia, radiolucent bone defects

Diagnostic Confirmation

If rubella infection is suspected during pregnancy:

• Obtain rubella-specific IgM antibody testing between 1-2 weeks after rash onset for optimal reliability 1
• Consider paired sera testing: acute-phase serum at symptom onset and convalescent-phase serum 10+ days later 1
• A four-fold or greater increase in rubella-specific IgG titers between acute and convalescent sera confirms infection 2
• Reverse transcriptase-PCR can detect rubella virus RNA 2

Prenatal Diagnosis Options

• Advanced prenatal diagnostic techniques (invasive or non-invasive) should be offered to distinguish cases with versus without fetal damage 5
• Detection of rubella-specific IgM antibodies in fetal blood can establish prenatal diagnosis and aid management decisions 6
• Important: Maternal infection does not guarantee vertical transmission in 100% of cases, and fetal infection does not always result in damage 5

Counseling About Pregnancy Outcomes

• Maternal rubella can lead to miscarriage, stillbirth, fetal anomalies, intrauterine fetal death, premature labor, and intrauterine growth retardation 3, 2
• Pregnancy termination should not be routinely recommended based solely on confirmed maternal infection—adequate prenatal counseling and diagnostic workup are mandatory 6, 5
• Prevention of unnecessary pregnancy termination is critical, especially in cases without confirmed fetal damage 5

Postpartum Management (Critical)

If the woman remains rubella-seronegative postpartum, immediate MMR vaccination before hospital discharge is essential: 1, 4

• This prevents congenital rubella syndrome in future pregnancies 1, 4
• Approximately 10-20% of women of childbearing age remain susceptible despite childhood vaccination programs 1
• Breastfeeding is NOT a contraindication to MMR vaccination 4
• Prior anti-Rho(D) immune globulin administration does NOT interfere with vaccine response 4
• Counsel to avoid pregnancy for 3 months following vaccination 1, 4

Key Clinical Pitfalls to Avoid

• Never give immune globulin for rubella exposure or infection in pregnancy—it doesn't work and provides false reassurance 1
• Never vaccinate during pregnancy—rubella vaccine is absolutely contraindicated due to live attenuated virus that can cross the placenta 3, 4, 7
• Don't rely on clinical diagnosis alone—rubella-like illnesses are unreliable; always confirm serologically 6
• Don't automatically recommend pregnancy termination—maternal infection doesn't guarantee fetal damage; offer comprehensive prenatal diagnosis first 6, 5
• Don't miss the postpartum vaccination opportunity—this is the critical window to prevent future congenital rubella syndrome 1, 4