GPs should encourage couples who are planning
to conceive to have counselling and
testing before conception.
Tests for infection should include:
• rubella IgG
• syphilis serology – TPHA or RPR
• hepatitis B serology – hepatitis B
surface antigen
• hepatitis C serology – hepatitis C antibody
• HIV
• varicella – IgG
• CMV IgG (in high-risk patients)
Women who have negative rubella serology
should be offered MMR vaccine and
retested for rubella seroconversion eight
weeks later. About 5% will need revaccination.
A very small number of women will
remain rubella seronegative despite two successive
MMR vaccinations.
It is unlikely that further vaccination will
lead to seroconversion. In these cases it is
best to counsel the woman to avoid rubella
contact in her subsequent pregnancy.
Women found negative to varicella IgG
should be offered varicella vaccine with two
doses, eight weeks apart. Pregnancy should
be delayed until eight weeks after vaccination
for rubella or varicella.
In those at high risk of CMV infection
(carers of young children), CMV IgG should
also be measured.
Seronegative women should be counselled
to practise thorough hygiene when in
contact with secretions of newborn infants
and toddlers.
A pre-pregnancy session will also allow
the GP to provide nutritional advice and
instructions on ways to minimise risks of
infection with toxoplasmosis, listeria and
other infections.
