By Dr. Nguyễn Ngọc Hưng*

On an average, a body temperature of 37.5 C is taken as normal. A higher than normal body temperature is known as pyrexia or fever.

A fever, by definition, is the body’s way of showing that the immune system is working to defend the body against an infection. The same thing is true of a fever during pregnancy since the body’s immune system is working harder to keep both you and your baby safe. This extra stress can make you more susceptible to virus and infections that lead to a fever. 

Risks of fever in pregnancy may include:

• Prenatal death.
• Miscarriage.
• Neural tube defects, such as spina bifida.
• Micropthalmia
• Cataract
• Microencephaly
• Functional and behavioral problems.
• Craniofacial developmental defects, such as cleft palate and/or lip.
• Problems with teeth and skeletal development.
• Cardiac developmental defects.
• Preterm delivery.
• The relationship between problems of CNS function (such as mental retardation, autism, schizophrenia, and cerebral palsy)
• Risks may be associated with cause of fever rather than the fever itself, such as congenital defects produced by the following infections – TORCH (toxoplasma, others, rubella, cytomegalovirus, and herpes). Included in the “others” category is parovirus B19, chicken pox, measles, enterovirus, adenovirus, hepatitis, and HIV.

 Symptoms of fever in pregnancy

The common symptoms are the same as you are likely to get with fever even when you are not pregnant:

• High temperatures
• Chills
• Headache 
• Sweating
• Fatigue
• Sore throat
• Muscle pain 
• Dehydration

Causes of fever in pregnancy

Viral Infection

The most common cause of a fever in pregnancy is a viral infection.

• Influenza – seasonal influenza, H1N1 influenza (swine flu).
• Viral infections such as measles, rubella, chicken pox and others.

Bacterial Infection

• Urinary tract infection (UTI).
• Respiratory tract infections such as pneumonia and bronchitis.
• Tonsillitis.
• Gastrointestinal infections, commonly associated with diarrhea.
• Appendicitis.
• Pelvic infection.

Fever caused by pregnancy

Chorioamnionitis is a bacterial infection of the amniotic fluid which surrounds the baby. Along with fever, there may be abdominal pain accompanied by uterine tenderness and contractions. A foul-smelling amniotic fluid or vaginal discharge may be present. If chorioamnionitis is diagnosed, the baby has to be delivered immediately, no matter what the gestational age, to avoid risk of a neonatal infection.

Traveller's fever when pregnant

There are a number of infectious illnesses that can be contracted while travelling and pregnant women should be more cautious especially if travelling to endemic areas. Some of the common infectious illnesses that may be contracted include :

• Malaria.
• Typhoid.
• Meningitis.
• Hepatitis.

Pregnant women should also be cautious of a fever after contact with an animal or insect whether there was a bite or sting or not.

Laboratory test

Investigations to find the cause of fever may be necessary, such as :

• Blood test, including white blood count.
• Blood culture.
• Strep throat culture.
• Sputum test.
• Urinalysis.
• Urine culture.
• Stool test.
• Spinal tap or lumbar puncture.
• If chorioamnionitis is suspected, amniocentesis for microscopy and culture may be needed.

Treatment of fever in pregnancy

• Medication should be taken only after consulting with a doctor. All drugs are not safe for use during pregnancy.
• Antipyretics to reduce the fever.
  • Acetaminophen is usually recommended.
  • Ibuprofen should not be taken by pregnant women.
• Cooling blankets or cooling fans to treat hyperthermia.
• Drink plenty of fluids to avoid dehydration.
• Adequate rest and enough sleep.
• Wear loose, comfortable clothes.
• Stay in a cool environment.
• The cause of fever has to be determined.
• Appropriate treatment of the cause of fever, including antiviral medication for viral infections and antibiotics in case of a bacterial infection.
• A urinary tract infection is common during pregnancy. If a woman has had more than one such infection or a kidney infection, she may be advised to take antibiotics throughout pregnancy to prevent the chance of recurrence.
• Uterine activity should be monitored and fetal well-being assessed by the doctor.
• Delivery may become necessary in some cases.

Prevention of fever in pregnancy

While prevention of fever in pregnancy may not altogether be possible, certain precautions can be taken.

• Vaccination against seasonal influenza and H1N1 influenza (swine flu) is recommended.
• Be up to date on all vaccinations.
• Avoid close contact with people who are sick.
• Wash the hands frequently with an antiseptic soap.
• Do not drink unpasteurised milk.
• Tanning beds, hot tubs and saunas and should be avoided during pregnancy.
• Preventive medicines should be taken as necessary, when traveling to another country. Hanoi French Hospital

*Dr. Nguyễn Ngọc Hưng is a specialist in Emergency, Internal Medecine & Infectious Diseases who has  joined the Hanoi French Hospital to bring his expertise to our customers and colleagues.

If you have any questions or want to book an appointment with our doctor, please contact us at 84 – 24.3577.1100, access www.hfh.com.vn, or email us at contact@hfh.com.vn. Address: 1 Phương Mai Str, Đống Đa Dist, Hà Nội