My nephew was born with congenital rubella and it was undiagnosed before his birth. Congenital infections are all preventable but if they infect the mother the baby can heave serious diseases.
I conducted a session at PHC on this to prevent anymore women becoming infected and transferring diseases to the fetus. A large group of women showed up and actively took part in the conversation. They asked questions and shared their own stories with other participants.
The talk ranged from various congenital infections to the need for immunization. Major chunk of the presentation was on prevention. Daily habits to maintain hygiene can greatly reduce multiple diseases. And these are all very simple steps that prevent major infections.
A very brave woman stepped up and told about her four children who all have Cerebral Palsy. She requested every woman there to go to trained midwives or doctors for the births of their children. Another woman mentioned how she had miscarriage after acquiring measles during pregnancy.
The participants were keen to follow the prevention steps and I encouraged them to carry this message forward to their sisters, neighbors and other women they know.
As a social awareness thing, I posted all the key points on my Facebook so that more people can read and share it with their friends. Here is the post:
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Congenital diseases are diseases present from birth. Congenital infections are infections which a woman acquires during pregnancy and transfers it to the fetus, hence the baby is born with them. These are real and can cause SERIOUS problems for newborns. I am listing some major ones and their prevention. If you know anyone getting married soon or planning a baby please make sure they read this. This can save lives.
Congenital infections are broadly listed as ToRCHeS which are Toxoplasmosis, Rubella, Cytomegalovirus, HIV, Herpes Simplex Virus 2 and Syphilis.
1. Toxoplasmosis Gondii: Mainly caused by cat feces or ingestion of undercooked meat. Most patients do not have any symptoms. In babies it can present as choreoretinitis (inflammation of the choroid and retina of the eye), hydrocephalus (a condition in which fluid collects in the brain) and calcifications within the brain.
How to prevent toxoplasmosis:
Do not drink unfiltered water. Wear gloves when you are gardening or handle soil and wash hands thoroughly afterwards. Wash raw fruits and vegetables properly. Do not eat raw or undercooked meat (a lot of women while cooking taste raw meat to check for spices and taste. Always taste the gravy and not the meat). Meat should be cooked to 152ºF (66ºC) or higher, or frozen for 24 hours in a household freezer (at less than -12ºC). Freezing meat before consumption appears to be the most effective intervention in preventing toxoplasmosis transmitted by meat. Wash the utensils, knives, basin that handled the raw meat. Do not drink unpasteurized milk. Stay away from cats during pregnancy, specially do not clean their litter boxes yourself (fresh cat feces are not infectious).
2. Rubella: Caused by respiratory droplets. Patient presents with rash, swollen lymph nodes and swollen and painful joints. Babies born to mothers who had rubella can present with cardiac defects, cataracts and hearing loss.
How to prevent rubella:
MMR vaccine is the main tool to prevent rubella. It is given at one year of age and then again at 3 years. If someone has never received it, it can be given at any age, until a month before pregnancy. Pregnant women should be tested for rubella immunity. If they are not immune, they should be counseled regarding avoidance of exposure to patients with rubella and receive postpartum rubella immunization. If a child has rubella keep him away from babies and pregnant women.
3. CMV: Caused by sexual contact and organ transplant. Usually does not show any symptoms. Babies can present with hearing loss, seizures, rash and calcifications in the brain.
How to prevent CMV:
Practice good personal hygiene throughout pregnancy, especially hand washing with soap and water after contact with diapers or oral and nasal secretions (particularly with a child who is in daycare). Wash well for at least 15 to 20 seconds. Avoid kissing children under age 6 on the mouth or cheek; instead, kiss them on the head or give them a hug. Do not share food, drinks, or oral utensils (eg, fork, spoon, toothbrush, pacifier) with young children. Clean toys, countertops, and other surfaces that come into contact with children's urine or saliva.
4. HIV: Caused by sexual contact and used needles. There are variable presentations in the patients. Babies present with recurrent infections and chronic diarrhea.
How to prevent HIV:
Practice safe sex. Wear condoms. Always use clean needles for bloodwork. Male circumcision greatly reduces HIV incidence in males and hence protects their female partners. Prevention of mother-to-child transmission of HIV involves Antiretroviral therapy for the pregnant woman and post-exposure preventative medicines for the infant.
5. HSV-2: Skin or mucous membrane contact. Patient usually does not have any symptoms but can present with rash. Babies present with meningioencephalitis (swelling in different layers of brain).
How to prevent HSV-2:
Screening has been proposed to identify women without HSV so they can take precautions to avoid acquiring the infection. Women with past history of HSV should be identified so they can be offered suppressive antiviral therapy, examined carefully for lesions at the onset of labor, and offered cesarean delivery, if indicated. Postnatal transmission of HSV can be prevented by counseling family members with active HSV lesions or a history of cold sores or HSV lesions in the recent past to avoid close contact with and avoid kissing the newborn infant. Women with herpetic breast lesions should not breastfeed from the affected breast until the lesions have resolved because direct contact with the lesions may transmit the infection to the infant. Mothers should use careful hand hygiene and cover any lesions with which the infant might come into contact.
6. Syphilis: Sexual contact. Can cause rash and various swellings. Often results in stillbirth; if the child survives he has facial and limb deformities and deafness.
How to prevent Syphilis:
Screening, contact tracing, contact precautions, and monitoring of close contacts of infectious patients for clinical or serologic evidence of disease. Practice safe sex.
Zika virus can cause miscarriages and smaller brain/head sizes of the babies. It is caused by mosquito bite and usual mosquito contact prevention should be followed (as done for malaria/dengue).
Group B Strep colonizes vagina and can cause pneumonia, meningitis and sepsis in babies. Pregnant women should be screened at 35-37 weeks of gestation with rectal + vaginal swabs.
Prenatal visit to the doctor should be made within 8-10 weeks of the pregnancy. They will rule out rubella, chicken pox, HIV, Hepatitis B, Herpes, sexually transmitted diseases, thyroid problems, sickle cell disease, thalassemia, etc. If you have epilepsy, high blood pressure, diabetes or thyroid disorder see your doctor before conception to get on the correct medicines which can be used during pregnancy. Take Folic acid 0.4 mg tablets from 3 months before conception for proper brain and spinal cord development. Avoid alcohol, smoking and gutka before and during pregnancy. Being overweight or underweight can increase other risks during pregnancy. Certain fish contain high amounts of mercury so check on them before eating. Get your gum diseases treated as they can lead to low birth weight and pre term labor. Majority of the women in this area have iron deficiency anemia so get tested and start the appropriate treatment.
The above information is verified and contains supportive data from UpToDate."
By Zainab Faiza
