The Occurrence of Congenital Defects in Children Following Maternal Rubella During Pregnancy

West Indian Babies with Multiple Congenital Defects

“…The attack rate is difficult to assess as the disease is so easily overlooked. Constitutional symptoms may be slight and the fleeting rash may be hidden by a dark skin, but foetal damage is not dependent on the severity of the mother's infection (Gregg et al, 1945), and the clinical features exhibited by the babies are strongly suggestive of maternal rubella. The tendency of West Indian babies to multiple severe defects is noteworthy.…”

“…A retrospective survey from Australia (Swan and Tostevin, 1946) referred to 64 infected mothers who gave birth to one baby with this triad and eight with defects of both heart and eye. The New South Wales report (Gregg et al, 1945) is more difficult to analyse: there were 99 deaf mutes and 10 children with eye and heart damage. 'A degree of microcephaly' was common, but only seven (Manson et al, 1960) reported 202 exposures, one triad and five children with lesions of heart and eye; a similar investigation in Australia (Pitt et al, 1961) recorded 61 exposures, one triad and two children with heart and eye affected.…”

“…In three other cases a suspicious illness, with a rash, occurred during the first trimester, and two women were in contact with rubella early in pregnancy, although they did not develop the disease. Contact is recognized as a cause of the syndrome (Gregg, Beavis, Heseltine, Machin, Vickery and Meyers, 1945;Swan, 1949;Lundstrom, 1952).…”

“…Swan recorded mongolism after rubella, and it has been suggested that deafness, often unilateral and incomplete, is the commonest consequence of infection (Jackson and Fisch, 1958). The characteristic cataract was said by Gregg (1941) to be morphologically unlike any other type of congenital or developmental cataract. Microphthalmos and nystagmus sometimes occurred in association with cataract, but retinopathy has been less frequently recognized, being mentioned only once by Gregg and once by Swan (1949), but the condition may not always be recognizable with an ophthalmoscope.…”

How many subjects are needed in a longitudinal birth cohort study?

“…It is appropriate to recall the major preventive strategies that have focussed on relatively rare outcomes. The two major discoveries in regard to congenitally acquired defects – that of the adverse developmental consequences of rubella infection in pregnancy and the structural malformations resulting from maternal ingestion of the medication thalidomide – were each spotted by observant clinicians 9,10 . A highly effective measure (immunisation) was put in place to prevent rubella infections in pregnant women, and thalidomide was withdrawn from use.…”