Pregnancy and your baby's eyes: infections, medicines and what a newborn check looks for

Parents-to-be and grandparents often ask the same quiet question at the booking visit: is there anything in pregnancy that can touch the baby's eyes? Some infections and medicines can matter, some can be prevented or checked for, and every newborn should have an eye check after birth. Having been exposed to one of them does not mean a baby will be affected.

This page covers the infections that can affect a baby's eyes, medicines and substances, the link with premature birth, and what the newborn eye check looks for. It is general information. It is not a reason to blame anyone.

Which infections in pregnancy can affect a baby's eyes?

A group of infections known as TORCH can: toxoplasmosis, rubella, cytomegalovirus (CMV), herpes simplex, and others such as syphilis and Zika. A 2024 review in the Yale Journal of Biology and Medicine says these infections can leave a pattern of eye findings, most often cloudy lenses (cataract), unusually small eyes and inflammation of the retina and the layer beneath it. The review adds that the exact way they disturb eye development is poorly understood.

The same review notes that antenatal screening and medical care have lightened the burden in some countries, while it remains a concern where resources are limited. Zika, spread by the bite of the Aedes mosquito, can cause congenital Zika syndrome, which includes small head size and damage at the back of the eye. Having an infection in pregnancy does not mean the baby will be affected. It means the baby's eyes are worth checking.

The action: if you are told you have had one of these infections in pregnancy, ask your doctor whether the baby should have an eye examination by a children's eye doctor, and when.

What is rubella in pregnancy, and can it be prevented?

Rubella (German measles) is usually mild in children, but the World Health Organization says a woman infected early in pregnancy has a 90% chance of passing the virus to her baby. This can cause congenital rubella syndrome, in which a baby can have hearing impairment, eye and heart defects and developmental delay. The eye findings can include a cloudy lens, which is why cataract in children sometimes begins before birth.

Prevention is vaccination. WHO states that a single dose of rubella vaccine gives more than 95% long-lasting immunity, and that the highest risk of congenital rubella syndrome is where women of childbearing age have no immunity, either from vaccination or from having had rubella. Before the vaccine, up to 4 babies in every 1000 live births were born with the syndrome.

The action: if you are planning a pregnancy, ask your doctor whether you are immune to rubella and, if not, about vaccination and its timing before you conceive.

What about CMV and toxoplasmosis, and how can the risk be lowered?

Both are common and usually harmless to the person who has them. The NHS says most babies born with congenital CMV have no symptoms, but it can cause problems including hearing loss and problems with the eyes. CMV passes through saliva, urine and other body fluids, and young children often catch it first at nursery.

The NHS advises washing hands with soap and water after changing nappies, feeding young children or wiping their noses, washing toys that have saliva or urine on them, not sharing food, cutlery or a dummy, and avoiding kissing a young child on the mouth. There is no vaccine, and the NHS says there is currently no treatment for CMV in pregnancy.

Toxoplasmosis comes from cat faeces, soil contaminated by cat faeces and undercooked meat. The NHS advises wearing gloves for gardening, washing hands before preparing food and after handling raw meat, washing fruit and vegetables, cooking meat thoroughly, avoiding raw or undercooked meat and cured meats, and avoiding cat litter, or wearing gloves and washing hands if you must empty a tray. It also says you cannot catch toxoplasmosis from stroking a cat or having one as a pet.

The NHS notes that babies born with congenital CMV may have tests of the eyes and hearing and regular follow-up appointments until they are about five years old. Ask the baby's doctor to include the eye examination in that plan.

Which medicines and substances matter for a baby's eyes?

Alcohol is one clear example. The Yale review describes fetal alcohol syndrome, which can include short eye openings, widely spaced eyes, a squint, small eyes, reduced vision and underdeveloped optic nerves. The review also names certain medicines linked to birth defects, including isotretinoin, a medicine for severe acne, and some anti-seizure medicines. It notes that much is still unknown.

The rule for medicines is simple and works both ways. Tell every doctor, pharmacist and dentist that you are pregnant or planning to be, and take no medicine, supplement or traditional remedy without asking. But do not stop a medicine you need on your own, such as one for epilepsy, asthma or high blood pressure. Stopping without advice can do harm. Instead, ask the prescribing doctor early, ideally before conception, whether it should be changed.

If you take isotretinoin, talk to the doctor who prescribed it before you plan a pregnancy, and straight away if you find you are pregnant. This is a medicine with a known risk of birth defects, so the plan needs to be made with the doctor, not around them.

What does antenatal care in Malaysia check?

The Ministry of Health's antenatal services, as the government portal lists them, begin with registering the pregnancy at a klinik kesihatan before 12 weeks. Regular visits include blood pressure, urine and blood tests, and growth checks. Free folic acid, iron and multivitamins are given, and screening tests include HIV, hepatitis B, syphilis, diabetes and high blood pressure. Syphilis is one of the TORCH infections above, so that screening protects the baby's eyes too.

The portal page does not list rubella, CMV or toxoplasmosis tests, and it does not describe rubella vaccination. That does not mean these are not offered; it means this page cannot tell you. Ask your antenatal doctor which tests apply to you, and whether you are immune to rubella. Whichever clinic you attend, keep the pregnancy record and bring it to the baby's first eye visit.

What if the baby is born early?

A baby born early needs eye checks that a full-term baby does not. The American Academy of Ophthalmology advises a comprehensive eye examination by an ophthalmologist for babies born prematurely. The reason is retinopathy of prematurity (ROP), in which the blood vessels at the back of the eye have not finished growing. Eye checks after the NICU explains the schedule, so it is not repeated here.

If your baby is in the neonatal unit, the team will arrange these checks. If you are not sure, ask the nurse or the paediatrician on duty which date the first eye examination is booked for, and write it down.

What does the newborn eye check look for?

It looks for the basics: how the eyes look, whether the pupils respond to light, and the red reflex. The American Academy of Ophthalmology says a doctor or another trained professional should check a newborn's eyes, and the check may include the red reflex, which is like seeing red eyes in a flash photograph, and the blink and pupil response. A light shone in each eye should return a red glow. If it does not, more testing may be needed.

A missing or uneven reflex can have more than one cause, including a cloudy lens (cataract) and, less often, a tumour of the retina (retinoblastoma). A policy statement from the American Academy of Pediatrics and eye-specialist bodies calls red reflex testing an essential part of the newborn, infant and child examination. The American Academy of Ophthalmology says any baby with an abnormal red reflex needs urgent consultation, and that babies with a family history of childhood cataract or retinoblastoma are in a higher-risk group.

The newborn check is a screen, not a full eye examination. Your baby's first eye check explains what comes next, and a white glow in photos explains what to do if you see one later. If your baby is a few weeks old and does not seem to look at you, my baby does not look at me yet is the place to start.

Common questions

References

1. World Health Organization · Rubella fact sheet · www.who.int
2. NHS · Cytomegalovirus (CMV) · www.nhs.uk
3. NHS · Toxoplasmosis · www.nhs.uk
4. Yale Journal of Biology and Medicine · External disruption of ocular development in utero (Kim et al., 2024) · pmc.ncbi.nlm.nih.gov
5. MyGOV Malaysia · Kesihatan ibu hamil (antenatal services of the Ministry of Health) · www.malaysia.gov.my
6. American Academy of Ophthalmology · Children's eye screening · www.aao.org
7. Pediatrics · Red reflex examination in neonates, infants, and children (American Academy of Pediatrics et al., 2008) · pubmed.ncbi.nlm.nih.gov
8. American Academy of Ophthalmology · What is retinoblastoma? · www.aao.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.