Norovirus Infections and Pregnancy
Saturday, March 03, 2007
Kenneth F. Trofatter, Jr., MD, PhD
Noroviruses are small, RNA viruses that do not appear to readily cross the placenta or directly affect the baby. These infections are often called ‘stomach flu’ and are also often mistaken for ‘food poisoning.’ They are usually accompanied by headaches, low-grade fever (less than that typically seen with the flu), chills, lethargy (tiredness), weakness, and muscle aches. The course of infection is usually limited to 2-3 days, but the nausea, vomiting (more common in children) and diarrhea (more common in adults) can result in dehydration and electrolyte imbalances very quickly. The latter are where our pregnant women get into trouble. With dehydration and electrolyte imbalances, pregnant women are at increased risk for preterm labor and for developing urinary tract infections (which may also contribute to preterm labor).
Noroviruses are spread by the ‘fecal-oral route’ in contaminated water and foods and can be passed directly between individuals. Onset of symptoms usually occurs within 24-48 hours after exposure. They are the source of very rapid and widespread outbreaks in close quarters such as schools, daycare centers, nursing homes, restaurants, hotels, and cruise ships and this is what has often led to the mistaken accusation of ‘food poisoning’ in those situations. Common contaminated sources of infection are raw or undercooked shellfish, swimming pools and lakes, wells and municipal water supplies, ice machines, and ill individuals who handle food sources. There are several different strains of Noroviruses and despite the fact that individuals develop ‘immunity’ to the viruses, the immunity often is not permanent and reinfection with the same or different strains readily occurs. Noroviruses are believed to cause about 300 deaths per year in the U.S., but these serious complications usually occur in very young children and elderly and debilitated individuals.
If you are pregnant and develop symptoms related to viral gastroenteritis, you should let your provider know. If you have a low-grade fever and if you are able to ‘keep up with your fluids’ during the acute phase of the illness, it is unlikely that you will develop serious complications related to the pregnancy. If you cannot keep up with the fluids, develop a high fever, begin having contractions or other symptoms of a more serious problem, let your provider know about these immediately. If you have a sick child at home with a Norovirus infection, wash your hands frequently, but don’t be surprised if you join them in their misery despite your best efforts. And when you feel well again, come back and visit me here!
8 Comments:
At Thu Jun 14, 06:31:00 PM 2007,
Anonymous said…
Yes just coming around from the same thing. I was hospitalized for it because it was so bad and I'm pregnant, but because of a computer glich I was thrown out still sick and dehydrated because they didn't think i was insured when in fact I not only have my husbands but my own also!
At Fri Jun 15, 01:16:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
The health care system has its problems, doesn't it?!? Fortunately, these infections don't last very long. Hope you feel better soon!
At Tue Feb 05, 08:59:00 AM 2008,
Anonymous said…
Thank you Dr, you have eased my mind. A colleague is back after the vomiting bug and I read that it is contagious for 2 weeks after recovery. I am 7 weeks pregnant and worried I could pick it up and pass it on to the child. Glad to hear that it may not pass through to baby.
At Wed Feb 06, 05:16:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous feb 5: You're welcome. Hope you don't catch it anyway! Good luck with the rest of your pregnancy! Dr T
At Fri Mar 21, 08:28:00 PM 2008,
Mss.Love said…
HI. I HAD A MISCARIAGE IN DECEMBER OF 07. I WAS 19 WEEKS. THE DOCTOR SAID I HAD A SICK WOMB AND THE INFECTIN MADE ME AND MY BABY SICK AND I WENT INTO EARLY LABOR BUT AT THE TIME I DIDNT KNOW THIS. THE DOCTOR ALSO IT WAS A BUG CALLED CHROMOINDITISE IF IM SPELLING IT CORRECTLY. I WAS JUST WONDERING COULD I GET MORE INFORMATIN ON THIS INFECTON?.
At Wed Mar 26, 06:39:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To MSS.love Mar 21: Your doctor probbaly told you that you had CHORIOAMNIONITIS. That is an infection of the membranes of the bag of waters and probably the placenta. This is not caused by one "bug" but usually by a bunch of different bacteria and other organisms called mycoplasma and ureaplasma. Go ahead and put "chorioamnionitis" into your search engine and that will give you a lot of information. I do worry that anyone who has had chorioamnionitis at that point in pregnancy might also have an "incompetent cervix." Why don't you ask your doctor about that possibility as well. An incompetent cervix which opens prematurely can lead to chorioamnionitis and the two are often hard to separate as to which came first. Thanks for reading. Dr T
At Thu Jun 05, 09:33:00 AM 2008,
Anonymous said…
I had a misscarriage at 11-12 weeks of pregnanacy in Nov 2008 due to some unknown infection. I had sligh spotting in the 5th and 6th week then again in 11 th week. But, in the 11th week the spotting increased to bleeding and 2 days before the miscarriage i was feeling sick and a day before had fever, chills and vomiting. Since I had nausea and spotting earlier the Doctor did not suspect I'll miscarry. On the day of miscarriage, I developed contaction and had a very painful misacarrige n the Dr. did a DNC.
During this pregnanacy I had strong pregnanacy symptoms like nausea, hearburn, breast soreness, fatigue to name a few.
Now I am trying again for the past 2 months. This month my period has been delayed by 5 days and I had spotting like its a begining of period. I dont know if its a period or it will stop with spotting. However, I do not have any pregnanacy symptom this time expect that my period is delayed.
I am worried that the first miscarrige due to infection cud have affected my fallopian tube although the Doc said in most cases it wont affect.
Why do I have spotting? some women don't have any spotting at all. Does it mean that my utress is not strong enough? Is there anyway, i can strengthen the utress?
i had very severe hear burns last time. What should I do to control such extreme heart burns.
If the spotting turns on to be a period then would you say its an very early miscarrige and is it ok if I can try again next month or should I wait for a few months again?
Could a Doctor please reply to my question. I would be very grateful to you to get my nagging doubts clarified.
At Sat Jun 07, 08:21:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous June 5: If you have not had a normal period since the D&C, I am concerned that you either have not yet ovulated normally, or that you might have developed "Asherman's syndrome." This is scarring of the lining of the uterus that can occur if you have a D&C that is preceded by infection inside the uterus. If you do not have a normal period within the next couple of months, you need to discuss this possibility with your doctor. If you develop Asherman's syndrome, it is very hard to get pregnant unless you get some help. Dr T
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