Rubella and pregnancy

Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash. Up to half of people infected with rubella don’t have any symptoms and may not even know they’re infected but still spread it to other people.

If you get infected during pregnancy, rubella can cause serious problems for your baby. Infection causes the most severe damage when the pregnant person is infected early in their pregnancy, especially in the first 12 weeks (3 months).

Rubella has been nearly eliminated in the United States because of the routine vaccination of children. Vaccination protects a person against rubella for life. But people who were never vaccinated as children can get infected. You can be vaccinated as an adult when you are not pregnant. 

Between 2005 and 2011, 67 cases of rubella were reported in this country. This is up from the previous period—2001 to 2004—when only 5 cases were reported. Vaccination is the best way to prevent infection. Today, less than 10 people in the United States are reported to have rubella and it is usually associated with travel and not being vaccinated.

Rubella is common in many other countries. Travelers can bring it into the United States, or you can get it when traveling outside the country.

It’s important to get vaccinated for rubella. Talk to your health care provider to make sure you’re protected against it. A blood test can provide you with information about your immunity to rubella

What are the signs and symptoms of rubella?

Rubella is usually mild, with flu-like symptoms followed by a pink or light red rash. The rash usually starts on the face, then spreads to the rest of the body. The rash lasts about 3 days. Other symptoms include:

• Low-grade fever (102 F/38.9 C or lower)
• Headache
• Loss of appetite
• Runny nose
• Sore throat
• Cough
• Red eyes or pink eye (conjunctivitis)
• Swollen glands in the neck or behind the ears
• Muscle aches or joint pain

Up to 7 in 10 (70 percent) teenage and adult women who get rubella develop arthritis. Arthritis is swelling and pain in your joints. Women who are infected with rubella may feel arthritis in their fingers, wrists and knees. This complication is rare in men or children who get rubella. In rare cases, rubella can cause serious problems, including brain infections and bleeding problems.

Some people have no symptoms so you may not know that you or they have rubella.

What causes rubella?

Rubella is caused by a virus (a tiny organism that can make you sick). It is not caused by the same virus that causes measles. It’s very contagious. It spreads through the air when an infected person coughs or sneezes, or by sharing food or drinks with someone who is infected. It also can be passed to a baby from a pregnant person who is infected.

A person with rubella may spread the disease to other people up to 1 week before they notice a rash. Infected people can continue to spread the disease up to 7 days after getting a rash.

People infected with rubella should tell their friends, family, and the people they work with if they have rubella. If your child has rubella, it’s important to tell their school or daycare provider. Telling others helps prevent the spread of rubella to even more people.

What problems can rubella cause during pregnancy?

Rubella can be serious for the baby, especially during the first 3 months. Having rubella during pregnancy increases the risk of: 

• Congenital rubella syndrome (CRS) – This is a condition that happens when a pregnant person passes rubella to their baby during pregnancy. It may cause your baby to be born with one or more birth defects, including heart problems, vision problems, deafness, intellectual disability, low birthweight, bone marrow problems, and liver and spleen damage. There is no cure for CRS. However, from 2005 to 2018, only 15 babies were diagnosed with CRS in the U.S., according to the Centers for Disease Control and Prevention (CDC).
• Miscarriage – This is when a baby dies before 20 weeks of pregnancy.
• Stillbirth  – This is when a baby dies after 20 weeks of pregnancy.
• Preterm  – This is birth that happens before 37 weeks of pregnancy

Can you pass rubella to your baby during pregnancy?

Yes. The best way to protect your baby is to make sure you’re immune to rubella. Immune means being protected from an infection. If you’re immune to an infection, it means you can’t get the infection.

You are probably immune to rubella because you were vaccinated as a child or you had the illness during childhood. A blood test can tell if you’re immune to rubella. If you’re thinking about getting pregnant and aren’t sure if you’re immune, talk to your health care provider about getting a blood test.  If you were not born in the United States or came as an adult you may not be vaccinated against rubella. Ask your health care provider to do a blood test to see if you are immune to rubella. 

If you’re not immune to rubella, here’s what you can do to help protect your baby:

Before pregnancy. Get the measles, mumps and rubella (MMR) vaccine. Wait 1 month before trying to get pregnant after getting the shot.

During pregnancy. You can be tested at a prenatal visit to make sure you’re immune to rubella. If you’re not immune, the MMR vaccine isn’t recommended during pregnancy. But there are things you can do to help prevent getting infected with rubella:  

• Stay away from anyone who has the infection.
• Tell your health care provider right away if you’ve been in contact with someone who is sick and may have rubella.

After pregnancy. Get the MMR vaccination after you give birth. It is safe to get the MMR vaccine while nursing. Being protected from the infection means you can’t pass it to your baby before they get their own MMR vaccination at about 12 months. It also prevents you from passing rubella to your baby during a future pregnancy.

What are the chances of passing rubella to your baby during pregnancy?

You’re more likely to pass rubella to your baby the earlier you become infected during pregnancy. For example:

• If you get rubella in the first 12 weeks of pregnancy, your baby has an 8 to 9 in 10 chance (85 percent) of getting infected. This is a very high chance.
• If you get rubella at 13 to 16 weeks of pregnancy, your baby has a 1 in 2 chance (50 percent) of being infected.
• If you get rubella at the end of your second trimester or later, your baby has a 1 in 4 chance (25 percent) of getting infected.  

If you have rubella during pregnancy, your baby’s provider will carefully monitor your baby after birth to find any problems early.

How is rubella treated?

There is no specific medicine to treat rubella. In many cases, the symptoms of the disease are mild. Staying in bed (bed rest), drinking fluids and taking medicines to reduce fever can help.

Pregnant people with rubella may be treated with acetaminophen to relieve their symptoms. In more serious cases, treatment may include blood transfusion or steroids. A blood transfusion is when you have new blood put into your body. Steroids are synthetic hormones that treat inflammation.

Contact your health care provider if you are pregnant and think you have rubella or have been exposed to the disease.

Last reviewed: August 2021

See also: Your baby’s vaccinations, Vaccinations and pregnancy