INFORMATION FOR WOMEN WHO HAVE BACTERIAL MENINGITIS DURING PREGNANCY OR BREASTFEEDING
What is bacterial meningitis?
Bacterial meningitis is inflammation of the meninges the layers surrounding and protecting the brain and spinal cord resulting from a bacterial infection. Bacterial meningitis typically is classified based on the type of bacteria that causes it. For instance, the most common bacterial species to cause meningitis in adults, and increasingly in children, is Streptococcus pneumonia. As the name suggests, this species causes pneumonia but also causes ear infections. Adults, including pregnant women, can have it in their bodies without experiencing lung or ear disease. In some cases, the organism spreads around the body through the blood and reaches the meninges, and the fluid called cerebral spinal fluid (CSF) that flows through the ventricular system of the brain and around the spinal cord. As a result of the immune system responding to the infection, the meninges become inflamed and doctors call this pneumococcal meningitis.
Pregnant women who live at home with the family can become infected more easily with S. pneumonia (pneumococcus) by breathing in droplets from infected people, this has always been the most likely agent to produce meningitis. There is another bacterial species that commonly has caused meningitis in young adults Neisseria meningitides (which is why this type of meningitis is called meningococcal meningitis). This species is less likely to affect you for a couple of reasons. First, its difficult to catch N. meningitides from casual contact. Instead, it typically spreads between people living in places with large numbers of people, namely college dormitories and military quarters. Consequently, meningococcal meningitis typically affects young adults on college campuses and military installations. These environments can include some pregnant women, but its not the most common environment for a pregnant woman. Second, there is a vaccine that has been given to preteens and teens for the past several years, and this has had a dramatic effect on reducing the bacterial meningitis rate in young adults.
There also are bacterial species that cause meningitis in young children and infants. One such species is Haemophilus influenzae (causes Hib meningitis) and the other is Listeria monocytogenes. Its possible that you can get a Listeria meningitis infection as a pregnant woman, but its very uncommon. Meanwhile, similar to N. meningitides, the rate of Hib has decreased substantially in recent years, because there is a Hib vaccine, which is given to young children, as they are the group that is most at risk for Hib meningitis and other illnesses that Hib causes. However, for both Hib and N. meningitides, exceptions exist in certain affluent communities of North America where the anti-vaccination movement has manipulated parents into avoiding these very important vaccines for their children. There is a vaccine against S. pneumonia, but it is given routinely only to people above age 65. Finally, it should be noted that there are numerous other bacterial species that also can cause meningitis, but generally, in pregnant women S. pneumonia is almost always at the top of the list. There also are non-bacterial causes of meningitis fungi and viruses but this report focuses on bacterial meningitis.
How common is bacterial meningitis during pregnancy?
Overall, bacterial meningitis occurs in about 31 per 100,000 people. It occurs more often in older people because the meningococcal vaccine has reduced dramatically the occurrence of meningococcal meningitis that is notorious for affecting young adults. However, pregnant women can develop meningitis, particularly from S. pneumonia. Factors increasing your risk for this include diabetes, homelessness, infection with HIV, history of alcohol abuse, skull fractures, winter and early spring season, and having immunoglobulin or complement deficiency.
How is bacterial meningitis diagnosed?
The presence of a headache together with a high fever raises a red flag for your doctor that you need to be worked up for meningitis, and the suspicion gets stronger if you also have a stiff neck, and if attempts to flex your neck (push down your head) cause pain, and if you show abnormalities of reflexes that are tested when your legs and knees are manipulated in certain ways. At this point, you will be checked for signs of elevated intracranial pressure (ICP), usually, the doctor does this by looking at your retinas with an ophthalmoscope. If there are no signs of an elevated ICP, you will be given a lumbar puncture (sometimes called a spinal tap), in which CSF will be drawn out from within your spine. The CSF sample is tested for the presence of bacteria, and also to measure the levels of glucose (sugar) and protein. These tests will distinguish between bacterial, fungal, and viral causes. Normally, there are no bacteria in CSF, so the presence of bacteria, along with an abnormally low concentration of glucose, suggests bacterial meningitis. This test, and additional tests, such as cultures to determine the type of bacteria, provide the official diagnosis, but because bacterial meningitis is a life-threatening emergency, doctors will make a working diagnosis based on the clinical presentation alone, in order to begin treatment even before the lumbar puncture.
Does bacterial meningitis cause problems during pregnancy?
Bacterial meningitis is a life-threatening condition. Survival depends on how quickly it is recognized and treated with antibiotic medication.
Does bacterial meningitis during pregnancy cause problems for the baby?
Since it is a life-threatening condition for the mother, the baby is entirely dependent on how the condition goes for the mother. The babys life is in jeopardy unless the mothers condition is recognized early and cured with antibiotic treatment.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the bacterial meningitis
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat my bacterial meningitis during pregnancy?
Antibiotic treatment is necessary in order to prevent maternal death. The most important issue affecting which antibiotic to select is whether the drug being considered can cross from the blood into the brain and reach the meninges and CSF. This leaves just a handful of drugs, the choice of which also depends on which bacterial species is causing the problem. When it is S. pneumonia, the choice based on safety and effectiveness is ampicillin, which is considered fairly safe in pregnancy. When this is not enough, another drug called vancomycin is added, which also is thought to be fairly safe in pregnancy.
Fever medication, such as the drug acetaminophen, also may be given, and this is not dangerous for the developing baby.
Who should NOT stop taking medication for bacterial meningitis during pregnancy?
Nobody should stop taking antibiotic medication for meningitis since the medication is the only way to prevent a fatal o
What should I know about choosing a medication for my bacterial meningitis during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat bacterial meningitis here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my bacterial meningitis when I am breastfeeding?
Bacterial meningitis is a severe life-threatening emergency, for which antibiotic treatment is given during an intense period of several days, which makes it unlikely that the patient is in a condition to breastfeed during the time that the medication is given.
What alternative therapies besides medications can I use to treat my bacterial meningitis during pregnancy?
There are no alternatives to medication.
What can I do for myself and my baby when I have bacterial meningitis during pregnancy?
Allow medical staff to work quickly to admit you to the hospital and to proceed with antibiotic treatment and needed support.
Resources for bacterial meningitis in pregnancy:
For more information about bacterial meningitis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles: