Dengue fever in pregnancy: Why you should be careful about this disease

A condition known as dengue fever is spread by mosquitoes and results in a high fever and some flu-like symptoms. A pregnant woman who contracts dengue fever runs the danger of transmitting the virus to her unborn child, raising the possibility of issues like low birth weight, premature birth, and even death.

Dengue fever outbreaks often take place in tropical and subtropical locations. Infected individuals with dengue fever account for one in four cases of illness and mild to severe symptoms. Serious symptoms necessitate medical attention, but mild symptoms typically go away on their own.

Dengue is a viral fever that is seen quite frequently in Singapore. In fact, in 2017 alone, 2520 cases have been diagnosed with Dengue fever in Singapore. The tropical climate teamed with breeding grounds for mosquitos makes it difficult to control Dengue. Normally, this looks more serious than it is, except when there is dengue fever in pregnancy.

Dengue fever

A high temperature and flu-like symptoms are common signs of dengue fever, a mosquito-borne disease. Usually only lasting two to seven days, it is transient. Most dengue fever patients experience mild symptoms, but occasionally, they can be serious or even fatal.

Similar to other mosquito-borne diseases like Zika and chikungunya, dengue fever can be dangerous for expectant mothers because women, particularly those in the third trimester, can pass the virus to their unborn child. Due to this, they may experience preterm birth, low birth weight, or possibly the unborn child’s death. Preeclampsia (high blood pressure), hemorrhaging, a low platelet count, and cesarean birth are other conditions linked to dengue fever.

Dengue fever and its effect on the body

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As mentioned earlier, dengue is one of the viral fevers transmitted by mosquitoes. It starts with a high-grade fever. The patient generally notices pain – headaches, and pain in the joints and legs. In addition, there might be a mild rash and bleeding through the nose and gums.

Dengue fever causes suppression and inactivation of platelets. Platelets are a vital component of the blood and are essential for clotting. In the absence of viable platelets, the body starts to bleed spontaneously and may cause the severe form of the fever – Dengue Hemorrhagic Fever.

However, the incidence of this severe form is low, and an early diagnosis usually prevents it. That said, any form of Dengue fever in pregnancy can be dangerous, and this is why.

Dengue in an early stage of pregnancy

An infected mosquito bite is how dengue is transmitted. The dengue virus, like all other viruses, is tiny. It can cross the placenta and enter the baby. So if Dengue fever happens during pregnancy, it not only affects the mother, it also affects the growing fetus.

If you get dengue fever in pregnancy, the chances of stillbirths are high. And if the baby is lucky enough, it may be born prematurely or with low birth weight.

When a woman is pregnant or shortly after giving birth, she can transmit the dengue virus to her fetus. Premature birth, low birth weight, and fetal death are all negative impacts of dengue. So, a seemingly harmless disease can cause a lot of distress to the mother and the baby.

Dengue fever symptoms in pregnancy

The symptoms of dengue fever during pregnancy can be moderate or severe. Symptoms of mild dengue fever include:

• Severe fever
• Vomiting and nauseous
• Rash from dengue fever (usually in the palms and soles with itching and swelling)
• Joint, muscular, and eye pain
• Swollen glands
• Headache

The milder symptoms of dengue fever, also known as dengue hemorrhagic fever, should go away in two to seven days, but severe cases necessitate rapid medical intervention. If left untreated, it may result in internal bleeding, shock (an abrupt drop in blood pressure), and even death.

After your fever has broken, the symptoms of severe dengue fever usually appear 24 to 48 hours later. These are some symptoms of severe dengue fever:

• Severe tummy discomfort and tenderness
• Having at least three vomits in a 24-hour period
• Bleeding in the nose or gums
• Trouble breathing
• Blood in the feces, urine, or vomit
• Tiredness, agitation, and irritation

Call your doctor right away if you suspect you may be pregnant while experiencing severe dengue symptoms. The risk of problems can be significantly reduced with early detection and rapid treatment.

Because dengue fever exhibits many of the same symptoms as mosquito-borne diseases like chikungunya and Zika, as well as malaria and typhoid fever, it can be difficult to diagnose. Therefore, be ready to tell your healthcare professional about your trip experiences and whether you have traveled to mosquito-prone places. In order to confirm a diagnosis, your doctor can also request a blood test.

How Is Dengue Fever Treated?

Unfortunately, no specific treatment for dengue fever exists. Fortunately, it runs its course and you get better. That said, even if it causes no direct damage to the body per se, a high fever can cause some complications. 

Go to the hospital or ER right away if you start feeling worse after your fever goes gone, such as starting to vomit or experiencing excruciating abdominal pain.

If it turns out that you have a severe case of dengue fever, you might need to stay in the hospital so that the staff can check your blood pressure, give you an IV to replenish lost fluids and electrolytes and perform blood transfusions if necessary.

Dehydration is common in an untreated case of Dengue. In addition, bleeding can happen externally or internally, so the doctor will keep a tab on the platelets. It causes temporary bone marrow suppression, and in people who suffer from anemia, this can cause complications.

So if the doctor suspects dengue, you would be admitted to the hospital and will receive plenty of fluids to keep you hydrated. In addition, your platelet count would be monitored during and after the fever, just to ensure that you do not start bleeding spontaneously.

Some pregnant women with low platelet counts get tocolytic agents, which are supposed to block contractions until platelet transfusions are within a safe range for birthing, in addition to intravenous fluids.

This approach can successfully treat severe dengue fever when detected early.

Dengue vaccine pregnancy

There is just one dengue fever vaccine available, called Dengvaxia, and it is only recommended for those between the ages of 9 and 45 who have previously contracted the virus or another dengue virus.

The vaccination is administered in three doses over the course of a year. The vaccine was authorized by the Food and Drug Administration in 2019 for Puerto Rican residents and children aged 9 to 16 who had dengue fever in areas where dengue fever epidemics are frequent including the Virgin Islands and American Samoa.

A high risk of severe dengue fever and hospitalization exists in those who have not yet contracted the disease and who receive the vaccine.

Image from iStock

Follow these precautions to prevent being bitten when visiting areas where dengue fever or other infections spread by mosquitoes have been reported:

• Opt for an EPA-approved insect repellent containing IR3535, Picaridin, 20–30% DEET, and lemon– or eucalyptus–oil.
• Cover your arms and legs with loose cotton garments.
• Remain in locations with air conditioning or windows and doors with screens.
• Steer clear of places where mosquitoes are prone to breeding, such as old tyres that are filled with water, water containers, animal dishes, and flower vases.

Protect your pregnancy from dengue fever

• If at all possible, stay away from dengue-risk areas while pregnant. Over 100 countries, particularly those in the tropics, have a high dengue prevalence.
• Research whether dengue is present in the nation you will be visiting.
• Before a trip, consult your healthcare physician.

Ways to protect yourself from mosquito bites

If you are in or will be visiting a region where dengue is a possibility:

• Apply an insect repellent that has received EPA registration.
• Put on long pants and shirts with sleeves.
• Opt for lodging with windows and doors that have screens. if it’s available, use the air conditioning.
• Take action to keep mosquitoes under control in and around your house.

Use insect repellents containing one of the following active components that have been approved by the Environmental Protection Agency (EPA). Longer protection is offered by active component concentrations. Even for pregnant and nursing women, EPA-registered insect repellents have been shown to be safe and effective when used as instructed.

• DEET
• Picaridin (known as KBR 3023 and icaridin outside the US)
• IR3535
• Lemon eucalyptus oil (OLE)
• menthane-diol para (PMD)
• 2-undecanone

Do’s and Don’ts for dengue in pregnancy

1. High-grade fever
2. headaches 
3. joint pain
4. bleeding through gums or nose

To sum it up… 

Don’ts

• Don’t take aspirin/ibuprofen
• Do not take cold baths
• Don’t procrastinate
• Avoid juices or glucose water-it will cause diarrhea.

Do’s

• If you feel like it, take paracetamol for pain
• Have plenty of fluids, especially ORS
• Visit your doctor if you are pregnant or if you suspect Dengue fever during pregnancy

When to call a doctor?

Image from iStock

Updates by Matt Doctor from TAP SG

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