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JOGC

No. 368-Rubella in Pregnancy

      Abstract

      Objective

      To review the epidemiology, natural history, evaluation, and prevention of rubella infection during pregnancy. This will aid obstetric care providers in counseling their patients regarding potentially devastating effects on the developing fetus and the importance of vaccinating susceptible women as appropriate.

      Outcomes

      Outcomes evaluated include fetal rubella infection, maternal seroconversion and response to rubella-containing vaccines.

      Evidence

      Medline, PubMed, EMBASE, and Cochrane databases were searched for articles in English on subjects related to rubella infection during pregnancy betweenn 1985 and 2017. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Other (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

      Valuation methods

      The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Recommendations for practice are ranked according to the method described in this Report.

      Guideline update

      The guideline will be reviewed 5 years after publication to decide if an update is required. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations

      Sponsor

      Society of Obstetricians and Gynaecologists of Canada.

      Recommendations

      • 1
        Screening for rubella serostatus is recommended as part of standard prenatal screening if a pregnant woman has no record of rubella past immunity and no proof of immunization against rubella (III-B).
      • 2
        Since the effects of rubella infection in pregnancy vary with the gestational age at the time of infection, accurate gestational dating should be established, as well as timing of rubella infection, as they are critical to counselling (II-3A).
      • 3
        In a pregnant woman exposed to rubella or who develops signs or symptoms of rubella or whose fetus presents ultrasound anomalies compatible with congenital rubella syndrome, serological testing for rubella immunoglobulin M and immunoglobulin G should be performed to determine immune status and risk of congenital rubella syndrome (III-A).
      • 4
        Women should be counselled about the possible risk of vertical transmission and informed regarding the option of pregnancy termination, especially if primary infection occurs prior to 16 weeks gestation (III-A).
      • 5
        Rubella immunization should not be administered in pregnancy but may be safely given postpartum, as long as there is no contraindication to receive a live vaccine (i.e., systemic immunosuppression). Consider delaying vaccination if the woman received any immunoglobulin-containing preparations, including Rh immunoglobulin or intravenous immune globulin, or blood products during pregnancy or the peripartum period, as there is potential for reduced vaccine effectiveness (III-B).
      • 6
        Women who have been inadvertently vaccinated in early pregnancy or who become pregnant immediately following vaccination can be reassured that there have been no cases of congenital rubella syndrome documented in these situations (III-B).
      • 7
        Women wishing to conceive should be counselled and encouraged to have their rubella antibody status determined if no record of rubella past immunity and no proof of immunization are available and undergo rubella vaccination if needed (III-B).

      Key Words

      Abbreviations:

      CRS (congenital rubella syndrome), CVS (chorionic villus sampling), IgG (immunoglobulin G), IgM (immunoglobulin M), IVIG (intravenous immune globulin), MMR (measles, mumps, rubella), MMRV (measles, mumps, rubella, varicella), NAAT (nucleic acid amplification techniques), PCR (polymerase chain reaction), WHO (World Health Organization)
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