Clinical Guidance for Ebola in People Who Are Pregnant

What to know

  • Who this is for: Healthcare providers working in emergency departments and labor and delivery units in U.S. hospitals.
  • What this is for: Guidance on how to screen people who are pregnant for Ebola virus disease (EVD) and how to care for pregnant women as patients under investigation (PUIs) for or with confirmed EVD, including considerations for pregnant healthcare workers.
  • How to use: This guidance is intended to help U.S. hospitals develop a plan for screening and treating pregnant PUIs or patients with confirmed EVD.

Recommendations

  • Healthcare providers caring for people who are pregnant in U.S. hospitals should be prepared to screen patients for EVD and have a plan in place to triage these patients.
  • Obstetric management of people who are pregnant with EVD, particularly decisions about mode of delivery for people in labor, needs to consider risks to the person, risks of exposure for healthcare providers, and potential benefits to the neonate.
  • Healthcare workers who are pregnant should not care for patients with EVD.
  • Pregnant PUIs or patients with confirmed EVD should be hospitalized, and CDC guidance for hospitalized PUIs or patients with confirmed EVD should be followed.

EVD and Pregnancy

No evidence currently exists to suggest that people who are pregnant are more susceptible to infection from Ebola virus (EBOV) than the general population. Earlier reports suggested that pregnant people are more likely to be at increased risk of severe illness and death when infected with EBOV during pregnancy.1 More recent reviews, however, have suggested that pregnancy is not associated with increased mortality or disease severity in people with EVD23. People who are pregnant with EVD are at an increased risk of adverse pregnancy outcomes, including fetal loss and pregnancy-associated hemorrhage1234. In previous outbreaks in Africa, almost all infants born to people with EVD have not survived, but whether EBOV was the cause of death has not always been known234.

EBOV can cross the placenta, and pregnant people infected with the virus will likely transmit it to the fetus. Placental tissues from patients with EVD have demonstrated EBOV antigen throughout numerous different types of placental cells on pathological exams.5 EBOV RNA has also been detected in amniotic fluid, placental tissue, fetal meconium, vaginal secretions, umbilical cord, and buccal swab samples from neonates. 26789Importantly, it should be noted that EBOV RNA can remain detectable in amniotic fluid, breast milk, and fetal tissue after maternal recovery from EVD.2 EBOV RNA has been found in pregnancy-related body fluids and tissues up to 32 days after maternal clearance of viremia26789. Therefore, proper infection control precautions should be taken when managing convalescent pregnant people.7

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infec Dis 1999;179 Suppl 1:S11-2.
  2. Foeller ME, Carvalho Ribeiro do Valle C, Foeller TM, et al. Pregnancy and breastfeeding in the context of Ebola: a systematic review. Lancet Infect Dis 2020; 20(7):e149-e158.
  3. Kayem ND, Benson C, Aye CYL, et al. Systematic review and meta-analysis: Ebola virus disease in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2022;116(6):509-522.
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  5. Muehlenbachs A, de la Rosa Vazquez O, Bausch DG, et al. Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings. J Infect Dis 2017;215:64-69.
  6. Oduyebo T, Pineda D, Lamin M, Leung A, Corbett C, Jamieson DJ. A Pregnant Patient With Ebola Virus Disease. Obstet Gynecol 2015;126:1273-1275.
  7. Caluwaerts S, Fautsch T, Lagrou D, et al. Dilemmas in Managing Pregnant Women With Ebola: 2 Case Reports. Clin Infect Dis 2016;62:903-905.
  8. Bower H, Grass JE, Veltus E, et al. Delivery of an Ebola Virus-Positive Stillborn Infant in a Rural Community Health Center, Sierra Leone, 2015. Am J Trop Med Hyg 2016;94:417-419.
  9. Baggi FM, Taybi A, Kurth A, et al. Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014. Euro Surveill 2014;19.
  • Kamali A, Jamieson DJ, Kpaduwa J, et al. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerg Infect Dis 2016;22.
  • Dornemann J, Burzio C, Ronsse A, et al. First Newborn Baby to Receive Experimental Therapies Survives Ebola Virus Disease. J Infect Dis 2017;215:171-174.