Consequences of confirmed maternal rubella at successive stages of pregnancy

Over a thousand women with confirmed rubella infection at different stages of pregnancy were followed up prospectively. Two-thirds of the women were multiparous. Pregnancy continued in 40%, and the infants were followed up after birth both clinically and serologically. The frequency of congenital infection after maternal rubella with a rash was more than 80% during the first 12 weeks of pregnancy, 54% at 13-14 weeks, and 25% at the end of the second trimester. The infection rate then rose again to reach a high figure in the last month. Follow-up was to 2 years of age--the findings in infected children being compared with those in children who had escaped infection. Rubella defects occurred in all infants infected before the 11th week (principally congenital heart disease and deafness) and in 35% of those infected at 13-16 weeks (deafness alone). No defects attributable to rubella were found in 63 children infected after 16 weeks. Continued surveillance of cases of confirmed rubella during pregnancy is recommended as an additional way of monitoring the effect of rubella vaccination.