Management of Measles in Pregnancy

Immediate Post-Exposure Management

Administer immune globulin (IG) within 6 days of exposure at 0.25 mL/kg body weight (maximum dose 15 mL) to prevent or modify measles infection in susceptible pregnant women, as recommended by the Centers for Disease Control and Prevention (CDC) 2
IG is specifically indicated for pregnant women as a high-risk group for complications, according to the CDC 2
Measles-containing vaccine cannot be used for postexposure prophylaxis in pregnant women, as stated by the CDC 2
Even if IG is given, it may reduce but will not eliminate risk, and infants with congenital measles have been born to women who received IG shortly after exposure, as reported by the CDC 2

Pregnant women with measles require hospitalization more frequently than non-pregnant adults, with 25% of adults with measles requiring ≥1 day of hospitalization, according to the CDC 3
Low birth weight infants are more common among pregnant women with measles, as reported by the CDC 4, 3

All women of childbearing age should have their measles immunity documented before pregnancy, and those without evidence of immunity should receive MMR vaccine, then avoid pregnancy for 4 weeks after vaccination, as recommended by the CDC 1
MMR vaccine should be administered immediately postpartum to susceptible women, according to the CDC 1
Pregnancy is an absolute contraindication to measles vaccination, as stated by the CDC 1, 2
No cases of congenital abnormalities attributable to measles vaccine virus have been documented among infants born to women vaccinated during pregnancy, as reported by the CDC 6
Household contacts of pregnant women should be vaccinated with MMR to protect the pregnant woman from exposure, as recommended by the CDC 6, 1

Do not delay IG administration beyond 6 days post-exposure, as efficacy is time-dependent, according to the CDC 2
Do not assume women born before 1957 are immune; up to 9.3% may be susceptible, as reported by the CDC 3