Good News/Bad News About Bacterial Meningitis in Pregnancy

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Whether you get your news headlines at the top of the hour on TV, on the front page of the newspaper, or, as is increasingly the case, on the home page of your Internet search engine, there’s a common recurring theme: information on a “new” disease is a frequent hot topic. While it’s important to be on top of what the scientific community is saying about emerging illnesses, it’s also crucial to remember that we still need to be aware of some that we’ve known about for a while—in some cases, for generations.

One potentially devastating disease in this category is known as bacterial meningitis. Meningitis refers to an infection of the lining of the brain known as the meninges. It’s technically not one disease but can be due to any one of a number of types of bacteria. (Other germs, such as viruses and fungi, can also cause meningitis.)

Although not common, bacterial meningitis can quickly be fatal or disabling. Although there are treatments, they’re not always able to be given in time to prevent complications. In addition, all age groups (including newborns and women of childbearing age) can contract the disease.

Medical science has come a long way in the past four decades in terms of being able to prevent some types of bacterial meningitis. Yet, there are still many unanswered questions, particularly when it comes to meningitis and pregnant women. We’ll do a brief review of the types of bacterial meningitis most relevant to pregnant women and talk a little bit on prevention. On the way, we’ll touch on a couple of as-yet unanswered questions.

Bacterial Meningitis 101

For those who follow the news and get concerned when thousands contract a new infectious disease, here’s a sobering statistic: worldwide, bacterial meningitis affects over one million people annually. Although the number of cases in the US has been decreasing, much of that decrease has been due to eradication of a type known as Hemophilus influenzae, which tended to affect older infants and toddlers before the use of a vaccine for that germ became routine. A couple that are more likely to affect adults, known as pneumococcal and meningococcal meningitis, are still around; meningococcal disease is more of a risk in closed areas (such as dormitories and military bases) and during gatherings of large crowds, such as certain religious pilgrimages.

Although pregnant women don’t appear to be at any higher risk for these types of meningitis, there is one bacterial infection that does pose a special risk. The germ known as Listeria monocytogenes, which is sometimes found in contaminated deli meats, cheeses and other foods, affects pregnant women at a higher rate than the general population. In addition to bacterial meningitis, it can cause miscarriage and premature birth.

Early symptoms of meningitis can look like a lot of other illnesses, even the flu. There may be a fever, headache and vomiting. As those meninges that wrap around the brain and spinal cord become more inflamed, there may be neck pain and difficulty moving the head. The illness can progress in a matter of hours; in order to avoid complications, it’s important to seek medical care immediately. Bacterial meningitis is a true emergency!

Physicians diagnose bacterial meningitis by performing a lumbar puncture (more familiar to most people as a spinal tap). It’s really the only way they know what germ is growing. Bacterial meningitis does respond to antibiotics. But since a lot of germs nowadays are resistant to some antibiotics, it’s important to get a sample to know what will work. Bottom line: if it’s recommended, say yes to the test.

It’s also important to get those antibiotics in promptly in order to minimize the chance of complications from the disease—so important, in fact, that if the doctor is suspicious for meningitis, she’ll usually give the medicine before performing the lumbar puncture. Now is not the time to wait and see what the test shows!

Meningitis and Pregnancy: What’s the Risk to the Baby?

Although getting meningitis is never a good thing, it’s worth exploring the question of the danger of Mom’s meningitis to the unborn baby. Unfortunately, there’s not much research on the effect of the common types of bacterial meningitis on the fetus. Looking at the small amount of research out there on this point, it appears that if a pregnant woman’s meningitis (other than Listeria) is successfully treated and she’s not about to deliver, the baby is likely to be OK.

The other good news is on treatment. There are a variety of medicines used to treat this illness, and they generally appear safe to use in pregnancy.

It’s also worth noting here that newborns can and do get meningitis. However, it’s most likely to be from a germ that’s picked up from the birth canal (uterus, cervix and vagina) during delivery from a Mom with no symptoms.

Preventing Meningitis

Not every case of bacterial meningitis can be prevented, but we’ve come a long way in finding ways to lessen the risk. There are now vaccines for both meningococcus and pneumococcus, those two more common causes in young adults. Women who are in, say, the younger half of childbearing age may have already had these vaccines as part of their routine child and teen shots. Although not routinely recommended in many adults, they’re given at an older age in people with special medical risks.

One of the meningococcal vaccines (there are now two, for different types of meningococcus) is generally deemed safe in pregnancy and is often recommended if at risk for the germ, either because there have been cases in the community or if there has to be travel to a high-meningitis area. There’s less data on the other, newer meningococcal vaccine and on the pneumococcal vaccine in pregnancy; discuss these with your provider if you feel you’re at risk.

Other than that, prevention is largely a matter of good handwashing, avoiding ill contacts, and calling your provider if you’ve been exposed (there are preventive medicines to take). Also have a conversation regarding foods to avoid to lower your risk of Listeria and avoid travel to a high-meningitis area.

Meningitis, like so many of the infections we hear about, is pretty scary. It’s also not all that common. Do your best to take simple, preventive steps to avoid infection, and call your provider for any question of exposure or suspicious symptoms. A little knowledge about preventing and treating infection goes a long way.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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