Rubella is very dangerous for a pregnant woman and her developing baby. Anyone who is not vaccinated against rubella is at risk of getting the disease. Although rubella was declared eliminated from the U.S. in 2004, cases can occur when unvaccinated people are exposed to infected people, mostly through international travel. Women should make sure they are protected from rubella before they get pregnant.

Infection with rubella virus causes the most severe damage when the mother is infected early in pregnancy, especially in the first 12 weeks (first trimester). During 2005-2015, eight babies with CRS have been reported in the United States.

Congenital Rubella Syndrome (CRS)

Congenital rubella syndrome (CRS) is a condition that occurs in a developing baby in the womb whose mother is infected with the rubella virus. Pregnant women who contract rubella are at risk for miscarriage or stillbirth, and their developing babies are at risk for severe birth defects with devastating, lifelong consequences. CRS can affect almost everything in the developing baby’s body.

The most common birth defects from CRS can include:

• Deafness
• Cataracts
• Heart defects
• Intellectual disabilities
• Liver and spleen damage
• Low birth weight
• Skin rash at birth

Less common complications from CRS can include:

• Glaucoma
• Brain damage
• Thyroid and other hormone problems
• Inflammation of the lungs

Although specific symptoms can be treated, there is no cure for CRS. Since there is no cure, it is important for women to get vaccinated before they get pregnant.

Vaccine Recommendations

Women who are planning to become pregnant should check with their doctor to make sure they are vaccinated before they get pregnant. Because MMR vaccine is an attenuated (weakened) live virus vaccine, pregnant women who are not vaccinated should wait to get MMR vaccine until after they have given birth. Adult women of childbearing age should avoid getting pregnant for at least four weeks after receiving MMR vaccine.

Pregnant women should NOT get MMR vaccine.

If you get rubella or are exposed to rubella while you’re pregnant, contact your doctor immediately.

Congenital rubella refers to the group of birth defects that occur in an infant whose mother is infected with the virus that causes German measles (rubella) during pregnancy. Congenital rubella occurs when the rubella virus in the mother affects the developing baby in the first 3 months of pregnancy. After the fourth month, if the mother has a rubella infection, it is less likely to harm the developing baby. The most common problems are hearing loss due to damage to the nerve pathways from the inner ear to the brain (sensorineural hearing loss), ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and heart problems. Other symptoms and signs may include intrauterine growth retardation, prematurity, stillbirth, miscarriage, neurological problems (intellectual disability, low muscle tone, very small head), liver and spleen enlargement (hepatosplenomegaly), jaundice, skin problems, anemia, hormonal problems, and other issues.

The number of babies born with congenital rubella is much less since the rubella vaccine was developed. Pregnant women who are not vaccinated for rubella and who have not had the disease in the past risk infecting themselves and their unborn baby.

What is congenital rubella syndrome?

Congenital rubella syndrome (CRS) is an illness in an infant caused by rubella virus infection in the mother during pregnancy. When pregnant women are infected with rubella virus, their babies also are exposed, which may result in serious complications. The rubella virus can cause babies to be born with defects such as cataracts, deafness, heart defects, and mental retardation, or the pregnancy can end in a miscarriage or stillbirth.

Who gets congenital rubella syndrome?

Any unborn infant may contract rubella if the mother is exposed to rubella virus during pregnancy. The severity of the effects of rubella virus on the infant depends largely on the time of gestation at which infection occurs. The risk of defects in the infant is highest during the first 12 weeks of the pregnancy and decreases thereafter with defects rarely occurring after the 20th week of the pregnancy. Because of widespread vaccination, rubella and CRS are rare in the United States.

How is congenital rubella syndrome spread?

The virus that causes rubella can be found in nose and throat secretions, such as saliva, sputum, or nasal mucus, of infected people and can be spread to others through sneezing or coughing. If a pregnant woman is infected, her unborn infant can develop CRS. Infants born with CRS shed large quantities of rubella virus from body secretions for up to one year and can transmit rubella to persons caring for them who are susceptible to the disease.

What are the symptoms of congenital rubella syndrome?

Congenital infection with rubella virus can affect virtually all organ systems. Deafness, eye abnormalities, and congenital heart defects are the most common symptoms of CRS. Neurologic abnormalities, such as a reduced head size (microcephaly) and mental retardation, and other abnormalities, including spleen, liver or bone marrow problems, and low birth weight may also occur.

How soon after exposure do symptoms appear?

Symptoms of CRS most often are apparent at birth but some symptoms, such as behavior disorders or developmental delays, do not appear until weeks, months, or years later.

How is congenital rubella syndrome diagnosed?

Laboratory tests on throat, urine, or blood samples are needed to confirm the diagnosis.

What is the treatment for congenital rubella syndrome?

There is no specific treatment for rubella in a pregnant woman that will prevent CRS in the infant.

How can congenital rubella syndrome be prevented?

Prevention of CRS is the main objective of rubella vaccination programs in the United States. Vaccination of as many individuals as possible is the best way to prevent rubella cases and outbreaks. One dose of rubella vaccine, administered at 12-15 months of age, is recommended for all children. All females of childbearing age should have documentation of rubella immunity.