Pregnant women in frontline of measles outbreaks in Canada

Measles is on the rise in Canada and poses serious risks to pregnant people and their newborns, yet discussion about how to protect this vulnerable group is notably lacking.

An article on measles and pregnancy by physicians working directly with measles outbreaks in Ontario summarizes key points for clinicians https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250606.

Measles in pregnancy increases the risk of infection with pneumonia, hepatitis, and even death, and increases the risk of miscarriage and premature birth. Intravenous immunoglobulin (IVIG) given up to six days after a measles exposure can help reduce the risk of infection or lessen the severity of infection, although this is usually provided in hospitals.

“We hope that our article will serve as a valuable resource for clinicians, many of whom may not have encountered measles in their clinical practice,” says Dr. Michelle Science, lead author and staff physician, Division of Infectious Diseases at The Hospital for Sick Children.

Infection control

Strict infection control procedures are required for pregnant people with measles because of the high infectivity of the disease. Ensuring everyone of reproductive age is up to date with measles vaccinations is important to prevent complications in pregnancy and in newborns.

“Acquiring the measles virus during pregnancy can have devastating and far-reaching impacts on a birthing parent and their unborn child,” says Dr. Michelle Barton, division head of Paediatric Infectious Disease at Children’s Hospital, LHSC, and associate professor at Western University’s Schulich School of Medicine & Dentistry.

“It can be quite serious, with some babies experiencing complications either immediately or several years later. Measles during pregnancy is not a walk in the park and we hope this article raises awareness about the potential harms it poses.”

Surprising lack of discussion

Dr. Catherine Varner, deputy editor, CMAJ, and an emergency medicine physician writes in a related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250820, “Given that current outbreaks and their rippling effects are concurrent with the lowest fertility rate on record in Canada, it is surprising there is not more discussion about protecting the health and psychological well-being of pregnant people.”

Protecting women who are pregnant or who are considering getting pregnant should be a priority for public health and the health system. Dr. Varner urges separate pathways to care for pregnant women with measles, such as providing urgent access to IVIG for pregnant people who are exposed and susceptible to infection, and for hospitals to ensure their protocols for managing people with measles or suspected measles are up to date, to minimize the risk of further infections and harm.

“Pregnant people are often at higher risk than the general population in infectious disease outbreaks,” says Dr. Varner. “As such, they cannot be an afterthought in preventive strategies and health care systems’ responses.”