Impetigo is a common, highly contagious bacterial skin infection caused by either Staphylococcus aureus or, less frequently, Streptococcus pyogenes. This condition results in characteristic sores or blisters on the skin’s surface. While typically a minor condition, its presence during gestation requires careful management to ensure the health of both the pregnant individual and the developing fetus.
How Impetigo Affects the Pregnant Individual
Impetigo is primarily a superficial infection, meaning the bacteria colonize the outermost layers of the skin after entering through a minor cut, scratch, or insect bite. The most common presentation is non-bullous impetigo, which begins as small blisters or pustules that quickly rupture and leave behind the characteristic honey-colored crusts. A less frequent form, bullous impetigo, involves larger, fluid-filled blisters that are more common in infants but can occur in adults and are caused exclusively by Staphylococcus aureus.
The physical symptoms, including itching and discomfort, can add to the general physical sensitivities of pregnancy. Although impetigo is usually a localized infection, the systemic spread of the causative bacteria can lead to rare, more serious complications. One such complication is post-streptococcal glomerulonephritis (PSGN), a kidney inflammation that can follow infection by certain strains of Group A Strep (Streptococcus pyogenes). Prompt treatment of the skin infection helps to significantly reduce this already low risk.
Assessing the Risk to the Developing Fetus
The question of danger to the developing fetus is a primary concern for any pregnant individual diagnosed with impetigo. Standard, uncomplicated impetigo poses minimal direct risk to the fetus because the infection remains confined to the superficial layers of the skin. The bacteria do not typically enter the bloodstream in sufficient numbers to cross the placental barrier, which acts as a protective filter for the fetus. Therefore, the primary risk is not a direct infection of the fetus in utero.
Concern arises only in rare instances where a severe, untreated maternal infection progresses to a systemic illness like sepsis, indirectly impacting the fetus due to maternal instability. Such severe progression is highly uncommon, but it emphasizes the need for timely and effective treatment.
A distinction must be made between common bacterial impetigo and the extremely rare, non-infectious skin condition known as impetigo herpetiformis (IH). IH is a form of pustular psoriasis unique to pregnancy that carries a significant risk of severe maternal and fetal complications, including placental insufficiency and stillbirth. This condition requires specialized medical management.
Navigating Safe Treatment Protocols
Prompt management of impetigo during pregnancy is important to alleviate maternal discomfort and prevent the spread of the infection. For localized cases, topical antibiotics are the preferred first-line therapy because they have minimal systemic absorption. Mupirocin ointment is a common topical antibiotic used effectively and safely during all stages of pregnancy.
If the infection is widespread, severe, or fails to respond to topical therapy, oral antibiotics become necessary. Physicians select broad-spectrum antibiotics known to be safe during pregnancy, such as first-generation cephalosporins (like cephalexin) or dicloxacillin. These medications have established safety profiles and are effective against the common causative bacteria. Always consult with an obstetrician or other healthcare provider before starting any medication to ensure the chosen treatment is appropriate for the individual’s specific health status and stage of pregnancy.
Measures to Prevent Infant Transmission
Preventing the spread of impetigo to the newborn (neonatal transmission) is a primary focus if the infection is active around the time of delivery or in the postpartum period. Impetigo is highly contagious and spreads easily through direct contact with the fluid from the blisters or the crusts. Strict hygiene practices are essential to minimize this risk.
Frequent and thorough handwashing with soap and water is the single most effective measure for preventing transmission. Any active lesions should be kept loosely covered with a clean bandage or gauze to contain the infectious material. Use separate towels and linens, washing them in hot water to eliminate the bacteria.
While breastfeeding is generally safe, any lesions on the breast or nipple must be completely covered or temporarily avoided to prevent direct transmission to the infant. Avoiding close facial contact, such as kissing the baby near the lesions, further reduces the chance of spread until the maternal infection has fully cleared following antibiotic treatment.