Measles in pregnancy: clinical considerations & challenges. Systematic review.

Dr.Suvarna  Palanivelu; Dr.Karthik  Shunmugavelu

doi:10.51168/sjhrafrica.v6i12.2414

Authors

Dr.Suvarna Palanivelu MBBS,MD(Obstetrics & Gynecology),DipNB, Associate Professor, Department Of Obstetrics & Gynecology, Meenakshi Medical College Hospital & Research Institute (Mmch & Ri),Enathur, Kanchipuram,Tamilnadu, India)
Dr.Karthik Shunmugavelu BDS, MDS OMFP, MSC(London), Mfdsrcs England, Mfdsrcps Glasgow, Faculty Affiliate Rcs Ireland, Mcip, Fibms(Usa),Affiliate Rcs Edinburgh, Associate Faculty Of Dental Trainers Edinburgh, Masid(Australia) Assistant Professor, Department Of Dentistry, Psp Medical College Hospital And Research Institute, Tambaram, Kanchipuram Main Road, Oragadam Panruti, Kanchipuram District Tamilnadu 631604 India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2414

Keywords:

Measles, Pregnancy, Maternal morbidity, Perinatal outcomes, Neonatal complications, Vaccination

Abstract

Background:

Measles remains a highly contagious viral infection with significant morbidity and mortality. Pregnant women constitute a high-risk group, with infection associated with severe maternal illness, adverse pregnancy outcomes, and neonatal complications. Recent outbreaks and immunity gaps among women of reproductive age necessitate a synthesis of current evidence.

Objective:

To systematically review maternal, fetal, and neonatal outcomes associated with measles infection during pregnancy and summarize clinical and preventive considerations.

Methods:

A systematic search of PubMed, Embase, Google Scholar, and the Cochrane Library was conducted from inception to December 2025. Observational studies, outbreak investigations, case series (≥5 cases), and systematic reviews reporting measles during pregnancy were included. Outcomes assessed included maternal morbidity and mortality, pregnancy loss, preterm birth, neonatal morbidity, and congenital measles. Quality appraisal used the Newcastle-Ottawa Scale, Joanna Briggs Institute tools, and AMSTAR-2. This review was not prospectively registered.

Results:

Fifteen studies involving over 1,000 pregnant women with measles were included. Hospitalization rates ranged from 60% to 96%. Pneumonia occurred in 18–40% of cases and encephalitis in up to 5%. Maternal mortality reached 12% in outbreak settings, with pooled estimates of 4.3%. Adverse pregnancy outcomes were frequent, including spontaneous abortion, intrauterine fetal death, preterm birth (13–31%), and low birth weight. Adjusted risks for fetal loss and neonatal morbidity were significantly higher compared with uninfected pregnancies. Early gestational infection was associated predominantly with pregnancy loss, whereas late gestational infection increased the risk of preterm birth and congenital malformation. Neonatal outcomes included increased NICU admission and prolonged hospitalization.

Conclusion:

Measles in pregnancy is associated with substantial maternal and perinatal risk. Preconception immunization and timely post-exposure prophylaxis remain central preventive strategies.

Implications and Future Research:

Prospective pregnancy registries, vaccine-era cohort studies, and gestation-specific management protocols are required.

Author Biographies

Dr.Suvarna Palanivelu, MBBS,MD(Obstetrics & Gynecology),DipNB, Associate Professor, Department Of Obstetrics & Gynecology, Meenakshi Medical College Hospital & Research Institute (Mmch & Ri),Enathur, Kanchipuram,Tamilnadu, India)

is an Associate Professor of Obstetrics and Gynecology with clinical and academic expertise in high-risk pregnancy, maternal infections, and adverse pregnancy outcomes.

Dr.Karthik Shunmugavelu, BDS, MDS OMFP, MSC(London), Mfdsrcs England, Mfdsrcps Glasgow, Faculty Affiliate Rcs Ireland, Mcip, Fibms(Usa),Affiliate Rcs Edinburgh, Associate Faculty Of Dental Trainers Edinburgh, Masid(Australia) Assistant Professor, Department Of Dentistry, Psp Medical College Hospital And Research Institute, Tambaram, Kanchipuram Main Road, Oragadam Panruti, Kanchipuram District Tamilnadu 631604 India

is an academic clinician with expertise in oral pathology, research methodology, and systematic evidence synthesis, with a strong focus on interdisciplinary medical research.

References

Rasmussen, S. A., & Jamieson, D. J. (2015). What Obstetric Health Care Providers Need to Know About Measles and Pregnancy. Obstetrics and Gynecology, 126(1), 163–170. https://doi.org/10.1097/AOG.0000000000000903

Enders, M., Biber, M., & Exler, S. (2007). Masern, Mumps und Röteln in der Schwangerschaft. Mögliche Auswirkungen auf Mutter, Schwangerschaft und Fetus [Measles, mumps and rubella virus infection in pregnancy.] Possible adverse effects on pregnant women, pregnancy outcome, and the fetus. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 50(11), 1393–1398. https://doi.org/10.1007/s00103-007-0195-9

Bodilis, H., Goffinet, F., Krivine, A., Andrieu, T., Anselem, O., Tsatsaris, V., Rozenberg, F., & Launay, O. (2014). Determinants of measles seroprevalence among pregnant women in Paris, France. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 20(8), O501–O504. https://doi.org/10.1111/1469-0691.12469

MotherToBaby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Measles, Mumps, and Rubella (MMR) Vaccine. 2024 Nov. Available from: https://www.ncbi.nlm.nih.gov/books/NBK597353/?utm_source=chatgpt.com

Anselem, O., Tsatsaris, V., Lopez, E., Krivine, A., Le Ray, C., Loulergue, P., Floret, D., Goffinet, F., & Launay, O. (2011). Rougeole et grossesse [Measles and pregnancy]. Presse medicale (Paris, France: 1983), 40(11), 1001–1007. https://doi.org/10.1016/j.lpm.2011.07.002

Guillet, M., Vauloup-Fellous, C., Cordier, A. G., Grangeot-Keros, L., Benoist, G., Nedellec, S., Benachi, A., Freymuth, F., & Picone, O. (2012). Rougeole chez la femme enceinte : mise au point [Measles in pregnancy: a review]. Journal de gynécologie, obstétrique et biologie de la reproduction, 41(3), 209–218. https://doi.org/10.1016/j.jgyn.2012.01.008

Arya, S. C., & Agarwal, N. (2005). Measles during pregnancy, including neonates. The Journal of Infection, 51(4), 340–341. https://doi.org/10.1016/j.jinf.2005.01.007

Manikkavasagan, G., & Ramsay, M. (2009). The rationale for the use of measles post-exposure prophylaxis in pregnant women: a review. Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology, 29(7), 572–575. https://doi.org/10.1080/01443610903104478

Campbell, H., Andrews, N., Brown, K. E., & Miller, E. (2007). Review of the effect of measles vaccination on the epidemiology of SSPE. International journal of epidemiology, 36(6), 1334–1348. https://doi.org/10.1093/ije/dym207

Bellini, W. J., Rota, J. S., Lowe, L. E., Katz, R. S., Dyken, P. R., Zaki, S. R., Shieh, W. J., & Rota, P. A. (2005). Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized. The Journal of Infectious Diseases, 192(10), 1686–1693. https://doi.org/10.1086/497169

Durrheim, D.N., Andrus, J.K., Tabassum, S. et al. A dangerous measles future looms beyond the COVID-19 pandemic. Nat Med 27, 360–361 (2021). https://doi.org/10.1038/s41591-021-01237-5

Measles-Related Complications in Young Pregnant Women in the Kyrgyz Republic. VER [Internet]. 2025 Nov. 13 [cited 2026 Jan. 25];8(8s):405-10. Available from: http://verjournal.com/index.php/ver/article/view/708

Chiba ME, Saito M, Suzuki N, Honda Y, Yaegashi N. Measles infection in pregnancy. Journal of Infection. 2003 Jul 1;47(1):40-4.https://doi.org/10.1016/S0163-4453(03)00045-8

Montroy J, Yan C, Khan F, Forbes N, Krishnan R, Tunis M, Salvadori MI. Post-exposure prophylaxis for the prevention of measles: A systematic review. Vaccine. 2025 Feb 15;47:126706. https://doi.org/10.1016/j.vaccine.2025.126706

Tunis, M. C., Salvadori, M. I., Dubey, V., Baclic, O., & National Advisory Committee on Immunization (NACI)* (2018). Updated NACI recommendations for measles post-exposure prophylaxis. Canada communicable disease report = Releve des maladies transmissibles au Canada, 44(9), 226–230. https://doi.org/10.14745/ccdr.v44i09a07

Joseph N. T. (2026). Measles in Pregnancy: Clinical Considerations and Challenges. Obstetrics and Gynecology, 147(1), 44–53. https://doi.org/10.1097/AOG.0000000000006126

Ali, M. E., & Albar, H. M. (1997). Measles in pregnancy: maternal morbidity and perinatal outcome. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 59(2), 109–113. https://doi.org/10.1016/s0020-7292(97)00196-3

Ogbuanu, I. U., Zeko, S., Chu, S. Y., Muroua, C., Gerber, S., De Wee, R., Kretsinger, K., Wannemuehler, K., Gerndt, K., Allies, M., Sandhu, H. S., & Goodson, J. L. (2014). Maternal, fetal, and neonatal outcomes associated with measles during pregnancy: Namibia, 2009-2010. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 58(8), 1086–1092. https://doi.org/10.1093/cid/ciu037

Eberhart-Phillips, J. E., Frederick, P. D., Baron, R. C., & Mascola, L. (1993). Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and gynecology, 82(5), 797–801.doi not available

Chiba, M. E., Saito, M., Suzuki, N., Honda, Y., & Yaegashi, N. (2003). Measles infection in pregnancy. The Journal of Infection, 47(1), 40–44. https://doi.org/10.1016/s0163-4453(03)00045-8

Congera, P., Maraolo, A. E., Parente, S., Schiano Moriello, N., Bianco, V., & Tosone, G. (2020). Measles in pregnant women: A systematic review of clinical outcomes and a meta-analysis of antibody seroprevalence. The Journal of Infection, 80(2), 152–160. https://doi.org/10.1016/j.jinf.2019.12.012

Khalil, A., Samara, A., Campbell, C., & Ladhani, S. N. (2024). Pregnant women and measles: we need to be vigilant during outbreaks. EClinicalMedicine, 72, 102594. https://doi.org/10.1016/j.eclinm.2024.102594

Ragusa, R., Platania, A., Cuccia, M., Zappalà, G., Giorgianni, G., D'Agati, P., Bellia, M. A., & Marranzano, M. (2020). Measles and Pregnancy: Immunity and Immunization-What Can Be Learned from Observing Complications during an Epidemic Year. Journal of Pregnancy, 2020, 6532868. https://doi.org/10.1155/2020/6532868

WHITE, SARAH J. PhD*,†; BOLDT, KRISTI L. MD‡; HOLDITCH, SARA J. BS§; POLAND, GREGORY A. MD*,†; JACOBSON, ROBERT M. MD*,∥. Measles, Mumps, and Rubella. Clinical Obstetrics and Gynecology 55(2):p 550-559, June 2012. | DOI: 10.1097/GRF.0b013e31824df256

Anselem, O., Tsatsaris, V., Lopez, E., Krivine, A., Le Ray, C., Loulergue, P., Floret, D., Goffinet, F., & Launay, O. (2011). Rougeole et grossesse [Measles and pregnancy]. Presse medicale (Paris, France: 1983), 40(11), 1001–1007. https://doi.org/10.1016/j.lpm.2011.07.002