Measles in Pregnancy: A Preventable Threat We Cannot Ignore

The recent resurgence of measles is more than a public health concern–it is an urgent warning, particularly for pregnant women. Once considered a disease largely under control through vaccination, measles is making a dangerous comeback in many parts of the world, placing expectant mothers and their unborn babies at significant risk.

Measles is a highly contagious viral disease caused by a single-stranded RNA virus of the Morbillivirus genus. It spreads through airborne respiratory droplets and is so infectious that the virus can remain viable in the air for up to two hours after an infected person has left the area. Humans are the only known natural host, making widespread vaccination the most effective means of prevention.

Pregnancy significantly increases the severity of measles infection. Studies have shown that the risk of death from measles is substantially higher among pregnant women than among the general population. Infection during early pregnancy also raises the likelihood of miscarriage, while maternal illness can lead to serious complications such as high fever, dehydration, pneumonia, breathing difficulties, and severe respiratory inflammation.

The disease typically begins with fever, cough, malaise, and conjunctivitis, followed by the appearance of Koplik spots inside the mouth and a characteristic red, maculopapular rash that spreads from the face to the rest of the body. Patients are contagious from four days before the rash appears until four days afterward, allowing the virus to spread rapidly if proper precautions are not taken.

Beyond the immediate illness, measles can result in life-threatening complications. Acute encephalitis, which may cause permanent brain damage, secondary bacterial pneumonia, ear infections, and the rare but fatal condition known as subacute sclerosing panencephalitis (SSPE) are among its most serious consequences.

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The unborn child is not spared. Measles virus can cross the placenta, exposing the fetus to infection before birth. Congenital measles may present with fever and rash shortly after delivery and can lead to severe neurological complications or even death. These risks highlight why preventing maternal infection must remain a public health priority.

Diagnosis relies on laboratory confirmation through measles-specific IgM antibodies, RT-PCR testing of respiratory samples, urine PCR, and molecular genotyping where available. There is, however, no antiviral treatment that eliminates the virus. Management is supportive, focusing on hydration, fever control, treatment of secondary infections such as pneumonia, and close monitoring by a multidisciplinary team that includes obstetricians, respiratory physicians, internists, and neonatologists. Hospitalisation is often necessary for pregnant patients with moderate to severe disease.

Prevention remains the most powerful weapon against measles. Because the measles, mumps, and rubella (MMR) vaccine is a live attenuated vaccine, it cannot be administered during pregnancy. Women planning to conceive should receive the MMR vaccine at least three months before becoming pregnant. Those who were not vaccinated before pregnancy should receive the vaccine after childbirth, as postpartum immunization is safe during breastfeeding and helps protect future pregnancies.

As measles cases continue to rise globally, public awareness and vaccination coverage must be strengthened. Protecting pregnant women from measles is not only about safeguarding maternal health–it is also about giving every newborn the healthiest possible start in life. Preventable diseases should never be allowed to become preventable tragedies.

The writer is an associate professor of Obs & Gynae department at Anwer Khan Modern Medical College Hospital