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Section 3 - Infections in pregnancy

 

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Protecting your baby

This section explains about some of the infections that can cause problems for you or your baby, but which can be treated. These are:

  • human immunodeficiency virus (HIV)
  • hepatitis B, and
  • syphilis.

There are screening tests for all these infections and your midwife will offer you these.

This animation gives information on the screening tests you will be offered during pregnancy for you and your baby.

Why are the tests recommended?

If you have one of these infections and it is not treated, your baby could catch the infection from you during the pregnancy, the birth or after the birth

Screening for HIV, hepatitis B and syphilis is offered and recommended in every pregnancy

All of these infections can be serious and if not treated they may cause problems for you or your baby. Most people with these infections will not feel ill and will not know they have these infections. If you have one of these infections, treatment will significantly reduce the chance of your baby catching the infection.
 

The test

The test is a blood test which can be done with other blood tests, usually early in pregnancy.
 

How are the tests done?

The screening tests for HIV, hepatitis B and syphilis can all be carried out on one blood sample. You can choose which tests are carried out. Only a small amount of blood is needed.
 

Why should I have the test?

By accepting screening for HIV, hepatitis B and syphilis you are deciding to find out if you have the infection so that everything possible can be done to protect your baby.
 

What if I decide not to be screened for HIV, hepatitis B or syphilis?

If you decide not to be screened for HIV, hepatitis B or syphilis your midwife will ask you the reasons why to make sure you have understood the reasons for the test. Later on in your pregnancy, your midwife will ask you if you want to discuss the screening and will offer you the test again.

You can ask to be screened for HIV, hepatitis B or syphilis at any time in your pregnancy. If, while you are pregnant, you are worried that you might have caught HIV, hepatitis B, syphilis or other diseases which can be passed between people, you can ask your midwife to do another test at any time during your pregnancy.

You can also get confidential testing from your nearest sexual-health clinic. If you need further information you can speak to your nearest NHS sexual-health clinic – phone your local hospital and ask for the sexual health or GUM clinic.
 

Human immunodeficiency virus (HIV)

What is HIV?

HIV is a virus that attacks the immune system. It is the virus that can lead to acquired immune deficiency syndrome (AIDS). A person infected with HIV can look and feel well for many years. They may not know they are infected unless they have a blood test. However, this virus can be passed on to their baby during pregnancy, childbirth or by breastfeeding.
 

How can HIV be caught?

HIV can be caught through:

  • a mother who is infected passing it to her baby during pregnancy, the delivery or breastfeeding
  • having unprotected sexual activity (without a condom) with someone who is infected
  • a blood transfusion or blood products containing the virus (these are tested in the UK but not in all other countries)
  • sharing infected needles and injecting equipment, and
  • contact with unclean needles used in body piercing and tattooing.
     

What are the advantages of having screening for HIV in pregnancy?

25% (1 in 4) of babies born to mothers who have an untreated HIV infection, or who do not know that they have an infection, will become infected with HIV.

If you are found to have HIV, a number of things can be done to lower the chance of you passing it to your baby. You will be offered specialist treatment and care. The treatment may also help to keep you in better health.

If you are found to have HIV and accept the treatment offered, the risk to your baby of having HIV will be reduced to 0.3% or less (3 in 1000 or less).
 

What are the disadvantages of having screening for HIV in pregnancy?

There is no good time to find out that you are HIV positive. However, if you find out when you are pregnant, you can have treatment to help stop your baby catching the virus from you.
 

Should I have the screening test for HIV?

Only you can decide whether to have the test or not. All hospitals in Wales recommend the screening test for HIV because if you are HIV positive it is possible to reduce the chance of your baby catching the virus.
 

What will the screening test result tell me?

A negative screening result tells you that you are very unlikely to have HIV infection. If you have caught HIV in the few weeks before the blood sample is taken, your body may not have started producing antibodies and the test will not be able to detect the infection. It is important to remember that you can catch HIV when you are pregnant. If you change your sexual partner during the pregnancy, you should use a condom.
 

What is the diagnostic test for HIV?

Sometimes the HIV blood test can give an unclear (reactive) result and further tests may be needed to confirm you do not have an infection. If the screening test shows that you are HIV positive, you will have another blood test to confirm the infection and guide treatment options.
 

What if I have HIV?

If the test shows you have HIV, you will be able to plan with your midwife or hospital doctor what happens next. You will be offered specialist medical care and treatment to help with the infection.

This will help reduce the risk of your baby getting the virus. Treatment will include drug therapy. This treatment will not cure you but it will improve your health. You may also be advised to have a Caesarean delivery and to feed your baby formula milk.
 

Does having the HIV screening test affect insurance policies?

Insurance companies should not ask if someone applying for insurance has had a test for HIV. They can only ask whether someone has had a positive test result. If you already have a life insurance policy it will not be affected by taking a HIV test, even if the result is positive, as long as you did not withhold any important facts when you took the policy out.
 

Hepatitis B


What is hepatitis B?

Hepatitis B is a virus that infects the liver. Many people who have hepatitis B do not know they have it. Most adults with hepatitis B make a full recovery, but a small number become ‘carriers’ of the virus. People who are carriers may develop serious liver disease.

If a pregnant woman has hepatitis B, her baby can be exposed to the hepatitis B virus during the delivery.

A baby who catches the virus may have the infection for life and may be at risk of liver disease.
 

How can hepatitis B be caught?

Hepatitis B can be caught through:

  • a mother who is infected passing it to her baby during delivery
  • having unprotected sexual activity (without a condom) with someone who is infected
  • having contact with the body fluids of someone who is infected
  • having contact with unclean needles used in body piercing and tattooing
  • sharing infected needles and injecting equipment
  • a blood transfusion or blood products containing the virus (these are tested in the UK but not in all other countries), and
  • living for a long time in close contact with someone who is infected.
     

What are the advantages of having screening for hepatitis B in pregnancy?

Testing for hepatitis B is important because if doctors know about the infection before a baby is born, a course of vaccinations started soon after the birth can help stop your baby catching the virus.

The vaccinations protect most babies from developing hepatitis B. If you have hepatitis B, there is up to a 90% (9 in 10) chance that your baby will become infected.

If you are found to have hepatitis B infection your baby can be vaccinated, and the chance of your baby being infected will be less than 5% (five in 100).
 

What are the disadvantages of having screening for hepatitis B in pregnancy?

There is no good time to find out that you have hepatitis B. However, if you find out when you are pregnant, your baby can be vaccinated to help prevent them from catching the virus from you.
 

Should I have the screening test for hepatitis B?

Only you can decide to have the test or not. All hospitals in Wales recommend the screening test for hepatitis B because if you have hepatitis B your baby can be vaccinated to help stop them catching the virus from you.
 

What will the screening test result tell me?

A negative screening result tells you that you are very unlikely to have hepatitis B infection. If you have caught hepatitis B in the few months before the blood sample is taken, the test will not be able to detect the infection.

It is important to remember that you can catch hepatitis B when you are pregnant. If you change your sexual partner during the pregnancy, you should use a condom.

If you are found to have hepatitis B infection your baby can be vaccinated, and the chance of your baby being infected will be less than 5% (five in 100).
 

What is the diagnostic test for hepatitis B?

Sometimes the hepatitis B blood test can give an unclear (reactive) result and further tests may be needed to confirm you do not have an infection. If the screening test shows that you have hepatitis B, you will need another blood test to confirm the infection.
 

What if I have hepatitis B?

If you have hepatitis B, your midwife or doctor will talk to you about how it will affect you and to plan the vaccinations your baby will need
 

Vaccinations should take place:

  • within 24 hours of birth (some babies will also need an injection of antibodies – hepatitis B immunoglobulin) at their first vaccination
  • at four weeks of age
  • at eight, 12 and 16 weeks of age (as part of normal baby vaccinations), and
  • at one year of age.

Your baby will also need a blood test at 12 to 13 months to make sure they have not got the infection.

You may also be worried that other people in your family have the infection. They can also be tested and vaccinated if necessary.
 

Syphilis


What is syphilis?

Syphilis is a serious bacterial infection. Most people who have syphilis are unwell for only a short time at first and they may not be aware they have it. But if syphilis is not treated, it can cause serious problems later in life, including brain damage and heart problems.
 

How can syphilis be caught?


Syphilis can be caught through:

  • a woman who has syphilis passing the infection to her unborn baby during pregnancy, or
  • having unprotected sexual activity (without a condom) with someone who is infected.
     

What are the advantages of having screening for syphilis in pregnancy?

A syphilis infection will be treated with antibiotics in early pregnancy and this will usually prevent your baby from catching syphilis. Occasionally, babies may also need antibiotics when they are born.
 

What are the disadvantages of having screening for syphilis in pregnancy?

There is no good time to find out that you have syphilis. However, if you find out when you are pregnant, you can have treatment to help prevent your baby from developing major problems.

If you are found to have a syphilis infection and it is not treated, there is a risk that the infection can lead to a miscarriage or harm your baby.
 

Should I have the screening test for syphilis?

Only you can decide to have the test or not. All hospitals in Wales recommend the screening test for syphilis because, if you have syphilis, treatment with antibiotics can help prevent your baby from developing major problems.

If you are found to have a syphilis infection and it is not treated, there is a risk that the infection can lead to a miscarriage or harm your baby.
 

What will the screening test result tell me?

A negative screening result tells you that you are very unlikely to have syphilis infection. If you have caught syphilis in the few weeks before the blood sample is taken, your body may not have started producing antibodies and the test will not be able to detect an infection.

It is important to remember that you can catch syphilis when you are pregnant. If you change your sexual partner during the pregnancy, you should use a condom.
 

What is the diagnostic test for syphilis?

Sometimes the syphilis blood test can give an unclear (reactive) result and further tests may be needed to confirm you do not have an infection. If the screening test is positive, you will be given an appointment with a doctor specialising in these types of diseases.

This doctor will ask you questions, including questions about previous infections, to make a diagnosis and decide on the best treatment. The results of the screening test for syphilis are not always easy to understand. Sometimes the result of the screening test will come back positive because you have had syphilis in the past and have been treated, or you have a different and less serious problem.
 

What if I have syphilis?

If you have syphilis, your midwife or hospital doctor will talk to you about how it will affect you. You will probably be given antibiotics and need more blood tests.
 

Other infections

If you get a rash or come into contact with someone who has a rash when you are pregnant, you need to tell your midwife or doctor.

You may need to have other blood tests to find out what has caused the rash. There are a few infections that cause a rash that are important to know about in pregnancy. These are German measles (rubella), chickenpox, measles and parvovirus infection (commonly known as slapped cheek).
 

Rubella

You will be protected from rubella if you have ever had two doses of a vaccine containing rubella.

You will need two doses of the vaccine if you haven’t had or cannot remember having had the vaccine. You will need these after your baby is born.

You will be given the first vaccine usually at your doctor’s surgery, and the second dose a month later.

If you are not sure what vaccinations you have had, you should ask your GP surgery to check your immunisation history, which may be recorded in your GP records.

Catching rubella during pregnancy is extremely rare in Wales but it can be very serious for your baby. It can cause a condition called congenital rubella syndrome (CRS). This can lead to deafness, blindness, cataracts (eye conditions) or even heart conditions in your baby. It can also, very rarely, result in the death of your baby.
 

Chickenpox

Chickenpox is a very common infection and most women will have had chickenpox as a child and will be immune. If you come into contact with someone with chickenpox or have chickenpox while you are pregnant, you may be offered treatment.

This will help to prevent or reduce the symptoms of the infection. 3 If you are not sure what vaccinations you have had, you should ask your GP surgery to check your immunisation history, which may be recorded in your GP records. 
 

Measles

You will be protected from measles if you have previously had the infection or if you have ever had two doses of a vaccine containing measles (for example, measles-rubella or measles-mumps-rubella in school, as a child, or at your GP’s surgery).

If you come into contact with someone with measles while you are pregnant or if you have measles in pregnancy, you may be offered treatment. This will help to prevent or reduce the symptoms of the infection. Measles is rare in the UK. If you catch measles in pregnancy your symptoms can be more severe.
 

Parvovirus

Parvovirus is usually a very mild infection in women but can occasionally cause problems in unborn babies. There is no vaccine to prevent this infection. In rare cases when women catch parvovirus in early pregnancy their unborn babies may have problems. If you have parvovirus in early pregnancy you will be offered some extra scans to look for signs of these problems in your baby.