CU Anschutz Maternal-Fetal Medicine Summer 2025 Newsletter

July 8, 2025

Welcome to the Summer 2025 edition of our CU Anschutz MFM e-newsletter! Measles has received a lot of attention lately and patients have many questions about the disease and how it relates to pregnancy. We also share valuable tips on summer travel for pregnant patients as well as the benefits of vaccination during pregnancy. ACOG, SMFM and the CDC all have information for providers on measles, travel and vaccines for pregnant patients.

Measles and Pregnancy

Over 1,100 confirmed cases of measles have been diagnosed in the U.S. in 2025 ¹, including in Colorado. Most cases (96%) are in individuals with no documented immunizations or are known to be unvaccinated. Measles is often introduced into communities by unvaccinated travelers who get infected during international travel. Recently (May 13), a flight from Istanbul to Denver has been linked to at least 7 cases and resulted in the exposure of a high number of travelers both on that flight and within Denver International Airport. In response to this and other outbreaks related to international travel, on May 28th, 2025, the CDC updated guidelines and recommended that all international travelers should be fully vaccinated against measles with two doses.

Patients may ask to have their immunity tested, similar to how we screen for Rubella immunity with NOB labs. However, commercial IgG tests are not 100% sensitive and may fail to detect preexisting immunity for measles. While titer levels from the lab have a high positive predictive value, if the titer is high there is immune protection; conversely, the negative predictive value is not as clear. The lab cut-offs are based on natural immunity - not vaccine-based immunity - and vaccination may not produce the same level of antibodies as infection. A patient can be immune even with low titer levels on Measles antibody testing.

The best way to document immunity is to verify the patient’s vaccination records, however if this is not possible, MMR vaccination can be offered. There is no harm in an additional dose of MMR vaccine, but for an immunocompetent patient, additional doses do not necessarily provide increased immunity. MMR is a live, attenuated vaccine and is not recommended during pregnancy due to a theoretical risk. However, if MMR is inadvertently received either during pregnancy or in early pregnancy, no special interventions are necessary.

Measles is NOT considered a TORCH infection; there are no associated congenital malformations. A measles infection during pregnancy is associated with an increased risk of pneumonia and hospitalization and may impact fetal growth and necessitate earlier delivery of the pregnancy with consequent risk to the neonate due to prematurity. If a pregnant patient has a known high-risk exposure to a measles positive patient and is not immune (i.e. vaccinated), IVIG can be administered. This would be best organized through infectious disease colleagues and requires prompt action as treatment should be given within 6 days of exposure. [In contrast, if a non-pregnant person is exposed and not vaccinated, the treatment is a dose of the MMR vaccine.]

¹ As of June 5, 2025, 1,168 cases in 35 states.

Travel and Pregnancy

As Summer is often a time of travel, we thought it would also be helpful to provide some helpful tips.

• To decrease risk of blood clots to legs or lungs, pregnant travelers should stay hydrated, move frequently and wear graduated compression stockings. If there are no contraindications, taking low dose aspirin around travel may also help to decrease risk.
• Airport security machines emit low levels of radiation. Most experts agree that the risk for complications from radiation exposure from these scanners is extremely low.
• Counsel against travel to areas where obstetric and neonatal care might not be able to meet the needs for their individual pregnancy and neonatal health risks.
• Many insurance policies do not cover the cost of medical treatment for pregnancy or neonatal complications that occur outside the United States. Pregnant travelers should strongly consider purchasing primary or supplemental travel health insurance that covers pregnancy-related problems and care of the neonate.
• Consider providing a document confirming due date and fitness to travel.
• Airlines have varying policies regarding pregnant travelers. Here are some examples:
  
  • United Airlines: After 36 weeks a medical certificate may be required (one source states <72 hours before travel).
  • KLM Airlines: Advise against flying after 36 weeks (and after 32 weeks with multiples) or within a week of delivery. A medical clearance may be required before travel.
  • JetBlue: Documentation is required for flight <4 weeks before due date, must be filled out <48 hours before flight.
  • British Airways: Doctor’s note and pregnancy record are required to fly after 28 weeks; no flying after 36 weeks for a singleton pregnancy.
  • Southwest: No restrictions but pregnant person cannot sit in exit row.
  • Frontier: No restrictions; however, website states that by traveling with Frontier pregnant travelers acknowledge and accept possible risks.
• If a patient has international travel planned that requires travel vaccines, a good resource is the CDC Yellow Book.

Vaccinations and Pregnancy

Information on vaccination may change seasonally and every patient is different. Please discuss with your providers if you have specific concerns. This information is current as of Summer 2025.

Benefits of Vaccination During Pregnancy

• Antibodies protect both mother & baby, “two for one” protection
• Pregnant patients and infants are at increased risk from diseases
  • Pregnant patients with influenza are twice as likely to be hospitalized
  • Babies <6 months old are at highest risk for many respiratory illnesses such as RSV and pertussis
  • COVID-19 infections in pregnancy have a higher risk of more severe complications
• Maternal vaccination is the best way to protect newborns until they can start to receive their own vaccines.

Who else should be vaccinated?

Anyone who is around the newborn and infant should be up to date on all routine vaccines, including Tdap, influenza, COVID-19, RSV, etc. This includes parents, siblings and any caregivers such as grandparents, nannies and babysitters. The best practice is to get vaccines at least 2 weeks before meeting the baby as it takes this long to develop antibodies after vaccination.

What about Hepatitis B?

• All children, adolescents and adults should be vaccinated against Hepatitis B. If a pregnant patient has not received, or completed, the vaccine series this can be given during pregnancy.
• The Hepatitis B vaccine is safe during pregnancy and breastfeeding.
• There are 5 different types of Hepatitis B vaccine. However, during pregnancy patients should receive Engerix-B, Recombivax HB or Twinrix.

Additional Information Sources

• CDC's Vaccinating Pregnant Women
• ACOG's Vaccine Resoureces
• ACNM's Immunization Resources for Providers

Sie Center for Down Syndrome at Children’s Hospital Colorado

The Sie Center for Down Syndrome at Children’s Hospital Colorado is one of the leading Down syndrome programs in the country. Our team provides medical, developmental, educational and therapeutic care that helps children and adolescents with Down syndrome thrive. Experts in pediatrics, neurodevelopment, psychology, physical therapy, speech therapy, feeding, occupational therapy and education provide your patients with access to the best care based on their individual needs. Through a comprehensive team approach, we provide individualized care and support to all our families. We also offer prenatal and neonatal consultations for families to learn more about the diagnosis of Down syndrome and available resources.

For more information or to refer a patient, contact our team at 720-777-6750 or [email protected].

News You Can Use

Join us for our next virtual CU Anschutz MFM CME Talk

Anna Euser, MD will present “Measles, Travel and Pregnancy” on Wednesday, July 23, 2025, 12-1 pm. For more information and to register for CME credit click here: Measles, Travel and Pregnancy | Children's Hospital Colorado Continuing Education

Sonographer Case Review Series

Karen Snyder, BS, RDMS, RDCS, and Maternal-Fetal Medicine specialist Dr. Bahram Salmanian will present the next sonographer-focused case review series on Wednesday, August 20, 2025, 12-1 pm. These quarterly virtual sessions will explore complex high-risk pregnancy cases, featuring real ultrasound imaging and associated outcomes. For more information or to be included on our series invites, please email [email protected].

Announcing New Medical Directors at Boulder and CHCO North

We are excited to announce that Dr. Jake Hirshberg has been named as our new Medical Director for our site at Boulder Community Hospital, and Dr. Leilah Zahedi-Spung as Medical Director at Children’s Hospital Colorado’s North campus in Broomfield. Both are dedicated leaders and have many years’ experience in maternal-fetal medicine.

Refer Your Patient

To refer a patient or for more information, call 303-315-6100 or fax 303-468-3481.

In UCH Epic, referrals can be submitted via Ambulatory Referral to OBGYN/MFM: (REF86). You MUST also select a location for referral to drop into our work queue.

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