With the summer months approaching, pregnant women are concerned about the risks to themselves and their baby in swimming pools and saunas. There is no question that the risk of bacterial, viral, and parasitic infections can increase during this time.
Why do these infections occur?
Contamination with respiratory and gastrointestinal bacteria, viruses, and parasites can occur when:
- Water is used repeatedly for bathing by individuals with respiratory infections.
- Water contains waste products from animals or humans.
- Water is stagnant from rivers and ponds and can be naturally contaminated.
- Elevated temperatures from saunas can encourage growth of organisms.
- There is poor maintenance of the water.
What particular infections should I worry about?
Viruses
Adenoviruses are a frequent cause of viral pneumonia, especially during the summer months with epidemics.
- Coxsackie
- Echo
- Hepatitis A
- Polio viruses
These viruses can be associated with fecal contamination from swimming pools. Echovirus has been associated with stillbirth. Coxsackie B can cause cardiac anomalies and neonatal infection if maternal antibodies have not crossed the placenta prior to birth. Polio is more of a concern outside of the United States where vaccination is not routine. Hepatitis A can cause premature labor.
Bacteria
- Pseudomonas aeruginosa
- This bacteria can be found in saunas. This has been associated with skin rash sometimes lasting for 2 weeks.
- Shigella
- Salmonella
- Leptospirosis
These can cause diarrhea and dehydration leading to premature labor. Leptospirosis occurs from water contaminated from dog and rodent urine. This pathogen can readily cross to the fetus.
Parasites
- Amebiasis
- Giardiasis
These can be found in contaminated ponds and streams. These can result in severe diarrhea and neonatal infection.
What precautions can I take in pregnancy?
Adequately chlorination
Chlorine levels should be between 0.4 and 1.0 mg/L. In a sauna, chlorine levels should be around 3.0 mg/L. Foaming in a sauna can impair the action of chlorine as a disinfectant.
pH properly maintained
The pH should be between 7.2 and 8.0 to keep the chlorine in its active form.
Identification of coliform bacteria
Culture or the presence of more than 200/ml coliform bacterial count shows unhealthy water conditions.
Water should be tested frequently
Pools tested during low use time may vary from bacterial counts obtained during times of high use. When temperature rise, as in hot weather or the use of a sauna, and large number of bathers are in the water—it is harder to maintain the chlorine level and the level must be checked more frequently.
Summary:
If proper levels of chlorine and pH are maintained, swimming can be considered safe during pregnancy. Proper hygiene should be enforced with all bathers showering prior to swimming and not allowing infants with diapers in the pool. Also, pools should be covered to avoid animals from urinating or defecating in the water. Avoid swimming in untreated water such as lakes and ponds which presents a greater risk of protozoal infections.
