Fatality is much higher in pregnant women versus non-pregnant women with Lassa and New World hemorrhagic fevers and can be as high as 30% in the third trimester in Lassa fever. Evacuation of the uterus via delivery, spontaneous abortion, or evacuation of retained fetal products can reduce maternal risk of mortality. Fetal and neonatal death has been shown to be as high as 100% and 80% when associated with Ebola virus and Lassa Virus, respectively.

The efficacy of ribavirin for post-exposure prophylaxis is unknown. The mainstay remains prevention, and “strict adherence to infection control measures is essential.” The risk of transmission increases sharply during the latter stages of disease as viral loads are high and hemorrhagic symptoms are more prominent.

Smallpox7: Pregnancy complicated by smallpox infection is more severe than in non-pregnant counterparts and appears to have a significant incidence of miscarriage or premature birth. Vaccination before pregnancy reduced the risk for death. All exposed mothers, as well as all infants and children, should be vaccinated within for days of first exposure.

Although fewer than 50 cases have ever been reported world-wide (three in the United States),⁹ fetal vaccinia may be a risk if mothers receive the vaccine. However, the vaccinia virus is considered to be non-teratogenic.

Smallpox vaccine should not be given as pre-exposure prophylaxis to a woman who is pregnant or who may become pregnant within 28 days. She should also avoid intimate contact or sharing a bed with someone who was vaccinated within 28 days and/or until the vaccination site has completely healed and the scab has come off. A woman who has received the vaccine should not breast feed until after the scab has detached. If a woman has been vaccinated and is pregnant or becomes pregnant within 28 days, there is no indication for induced abortion.⁹

Tularemia: WGCB tularemia recommendations: Antibiotics, the primary classes, streptomycin, gentamicin, quinolones and doxycycline, are often avoided in pregnant and pediatric patients; however, they are recommended based on risk-benefit analysis in bioterrorism settings. A 2012 retrospective study suggested that, while aminoglycosides and tetracyclines are the only FDA approved antibiotics for the treatment of Tularemia, fluoroquinolones may be safer, used for a shorter duration, and have equal efficacy to tetracyclines for alternative outpatient treatment of Francisella Tularensis. Fluoroquinolones are already often used in some regions of the United States, although formal studies are not available.¹⁰

Organophosphates (Nerve Gas):

A retrospective review was done in 2011 of 21 pregnant patients with self-inflicted organophosphate exposure in India. Only atropine was used for treatment, as pralidoxime was not available. They reported that if the mother survived, a favorable short term fetal outcome could be expected, as no congenital abnormality or neurological deficit was observed in any baby.¹¹