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This story was originally published by The 19th.

A deadly measles outbreak in Pennsylvania, which has infected more than 975 people this year and been linked to five deaths, has also infected at least 50 pregnant women in the state. Doctors in outbreak areas are making changes to how they care for pregnant patients and their babies, offering a glimpse of what may be in store across the nation as cases spread.

Among the deaths were two infants in Lancaster County, an area about 60 miles west of Philadelphia and the epicenter of the Pennsylvania outbreak. A newborn had congenital measles, which was passed in utero through an unvaccinated mother who was infected. It is not clear whether the other infant, who was reportedly 6 weeks old at the time of death and had a genetic birth disorder, was exposed in utero or after birth.

Some Pennsylvania-based doctors have experienced an uptick in anxious questions from patients about the implications of measles on just about all aspects of pregnancy care: What do more cases mean for a current pregnancy? Are additional precautions needed for someone planning to get pregnant soon? How concerned should parents with a newborn be about public outings?

It all depends, doctors in Pennsylvania and nationally told The 19th, on preventative care measures taken prior to pregnancy and a person’s proximity to an outbreak. What is certain is that new cases of congenital measles and increasing exposure risks are putting a spotlight on the vulnerabilities of pregnancy and postpartum care in America in an era of lowering vaccination rates.

“Air doesn’t know that there’s a border between Pennsylvania and Ohio, or that there’s a border between New Jersey and New York,” said Dr. Sharee Livingston, an OBGYN in Lancaster County. “We are dealing with a respiratory illness, and even if we weren’t dealing with a respiratory illness, none of us live in a vacuum.”

US Surpasses 4,000 Cases of Measles, Highest Numbers Seen in a Generation

Livingston never came across a single case of measles during her medical training in the mid-2000s, and neither did many of her peers.

But in the past six months, Livingston estimates that she has treated at least a dozen patients infected with the highly contagious disease. Livingston did not share more information about the patients, including whether they were all women or if any were pregnant.

The Pennsylvania Department of Health (DOH) told The 19th that, as of Friday, a total of 977 measles cases had been reported in 2026, and 53 of those were among pregnant women. As of early October state health officials have reported nearly 40 percent of Pennsylvania’s cases were coming from Lancaster County. The five measles-associated deaths — the infants, a 40-year-old woman, an 18-year-old and a 20-year-old with leukemia — were the first in the state in 35 years.

“Measles wasn’t a conversation we were having before, but it is now,” said Dr. Kisha Davis, president-elect of the American Academy of Family Physicians.

DOH told The 19th it could not confirm any estimate of the number of congenital measles cases in the state or provide more details about the infected pregnant women, citing state privacy laws. The department said there is no nationally standardized definition for congenital measles and that it is working with the Centers for Disease Control and Prevention to develop a system for tracking and reporting cases. They have been tracking cases during pregnancy and in “very young children” and said that since Oct. 2, more than 100 measles cases in the state have been in children under the age of 4. NBC News reported that at least six newborns in the state have been infected with measles during the outbreak, citing a Pennsylvania doctor.

There have been more than 3,800 confirmed measles cases in the United States this year, the highest number in decades. Roughly 95 percent of the infections are among unvaccinated people or individuals whose vaccination........

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