Dengue is common in Sri Lanka, and 2026 has been a heavy year for it. If you are pregnant, dengue needs to be taken more seriously than it would be otherwise — not because it usually goes badly, but because the margin for delay is smaller.

The good news is that the most important thing you can do is also the simplest, and it is in this first section.

If you are pregnant and develop a fever, get seen today

Not tomorrow, and not after waiting to see whether it settles. Any fever in pregnancy should be assessed the same day, in the current situation in Sri Lanka.

National guidance is that pregnant women with an acute fever are admitted to hospital for monitoring — even if the first blood test looks normal, and whatever day of fever it is.1 Some women may instead be monitored very closely under their consultant's supervision. But that is a decision for a doctor to make after examining you. It is not a decision to make at home.

We would rather see a hundred women with an ordinary viral fever than miss one with dengue.

Why we ask for this

Pregnancy changes how dengue behaves. Pregnant women are more likely than others to develop the more severe form of the illness, and when it does occur it tends to be more severe.1,2 Dengue can also move quickly — someone who seems well in the morning can need active treatment by the evening.

That is the reason for seeing a doctor early rather than watching and waiting at home. Women who come in early and are monitored properly generally do well. Most of the difficulty with dengue in pregnancy comes from arriving late, not from the illness being untreatable.

Get help immediately if you have any of these

If you are already unwell with fever, go to hospital straight away if you develop:

  • Severe abdominal pain
  • Repeated vomiting, or being unable to keep fluids down
  • Any bleeding — nose, gums, black stools, or vaginal bleeding
  • Feeling faint, dizzy, or unusually drowsy, restless or confused
  • Cold, clammy hands and feet
  • Not passing urine for four to six hours
  • Reduced baby movements

These are the signs that matter most. Do not wait for a scheduled appointment.

What dengue feels like

Dengue usually begins suddenly with a high fever, along with some combination of:2,5

  • Severe headache, often with pain behind the eyes
  • Aching muscles, joints and back
  • Nausea, vomiting or loss of appetite
  • A flushed appearance early on, and later a rash
  • Feeling profoundly tired

Some people also have a cough, a sore throat or loose stools. These do not rule dengue out, which is a common reason it gets missed early.

One useful clue: if someone in your household or immediate neighbourhood has had dengue in the past two weeks, mention it to the doctor. Dengue tends to occur in clusters, and that piece of information genuinely changes how a fever is assessed.

Feeling better is not always getting better

This is the part of dengue that surprises people, and it is worth understanding.

In most fevers, the temperature coming down means the worst is over. In dengue it can be the opposite. For some patients, the few days after the fever settles are when the illness becomes riskiest, as fluid can start to leak out of the small blood vessels.1,2

You do not need to follow the medical detail of this. What you need to take from it is simple: do not leave hospital or stop monitoring just because you feel better and the fever has gone. Your doctors will keep checking you through that window for good reason.

Paracetamol only — never NSAIDs or aspirin

This matters enough to state on its own.

For fever and body aches in dengue, paracetamol is the only painkiller you should take.1,5 Do not take ibuprofen, diclofenac, mefenamic acid, aspirin or any similar anti-inflammatory medicine, and do not take steroids unless a doctor has specifically prescribed them.

These medicines increase the risk of bleeding, which is already a concern in dengue. Because they are so commonly used for body aches, and easily bought without a prescription, this is one of the more frequent avoidable problems we see. If you have already taken some before realising, tell your doctor — it is useful information, not something to hide.

Keep to the paracetamol dose you are given, and use tepid sponging for a high temperature.

Fluids

Keeping your fluids up matters, but plain water alone is not ideal. Fluids containing salts and sugars are better — oral rehydration solution, king coconut, fruit juice, soups or thin porridge (kenda).

One practical tip you may be given in hospital: avoid red, black or brown coloured drinks and foods. If you do vomit, it makes it much easier to tell whether there is blood in it.

What treatment involves

There is no medicine that kills the dengue virus.2 Treatment is about careful monitoring and giving exactly the right amount of fluid at the right time — which is precisely why it is done in hospital rather than at home.

Expect frequent checks of your pulse, blood pressure and urine output, repeated blood tests, and scans to look for fluid. If your blood count is taken repeatedly, that is normal and not a sign that something is wrong.

You may hear a lot about platelet counts, from staff and from relatives. Try not to fix on the number. A low platelet count on its own does not usually mean you need a transfusion, and it is only one of many things your team is watching. Ask your doctor how you are doing rather than tracking a single figure.

What it means for your baby

In most cases, the baby comes through well when the mother is looked after properly. The main risk to your baby comes from you becoming seriously unwell, which is another reason early care matters.

If you have dengue around the time of delivery, the virus can occasionally pass to your baby.1 Babies born in that situation are kept under observation in hospital for about a week. Dengue in newborns is usually mild, but it is watched for carefully so that it is picked up early.

If you are close to your due date

If you develop dengue in late pregnancy, your care will involve an obstetrician working alongside physicians and, if needed, an anaesthetist and paediatrician.

Where possible, delivery is delayed until the riskiest phase of the illness has passed, because both surgery and childbirth carry more bleeding risk during that window.1 If labour starts on its own, medication may be used to try to hold it off for a short period. If delivery cannot be delayed, it goes ahead with a full team and blood products ready.

This can be a frightening time, and decisions may be made that feel counterintuitive — including waiting rather than delivering. Ask your team to explain their reasoning; they will expect the question and should take the time to answer it.

Recovering afterwards

Once you are through the illness, expect to feel washed out for a while. Rest at home for about a week and avoid strenuous activity until you are told your blood counts have recovered. An itchy rash on the palms and soles as you recover is common and settles on its own.

You are not infectious to the people around you. But if someone else in the household develops a fever, they should seek care early too — dengue runs in household clusters.

Avoiding mosquito bites — the daytime problem

The mosquito that carries dengue, Aedes, bites during the day, most actively in the early morning and late afternoon.2,3 This catches people out, because the instinctive protection — a bed net at night — is not the main defence here.

  • Check for standing water every week. Flower pot trays, discarded containers, tyres, blocked gutters, water tanks, roof valleys and even bottle caps are enough. This is the single most effective thing a household can do.3
  • Use mosquito repellent, which is safe to use in pregnancy. Apply it to exposed skin during the day, not just in the evening.
  • Cover up with long sleeves and long clothing during peak biting hours.
  • Use screens on windows and doors, and a net if you rest during the day.
  • Be extra alert if there is dengue nearby — in your household, your lane or your workplace.

What about the dengue vaccine?

People often ask about this, and the answer is straightforward.

The dengue vaccine currently available (Qdenga) should not be given during pregnancy, because it is a live vaccine.4 It is also not given while breastfeeding. Women who are planning a pregnancy are advised to avoid conceiving for at least a month after vaccination.

If you were vaccinated before you knew you were pregnant, please do not panic — follow-up of women in that situation has not shown a pattern of harm. Do mention it to your doctor so it can be noted.

The bottom line

If you are pregnant and get a fever in Sri Lanka, be seen the same day and let a doctor decide what happens next. Take paracetamol only, never anti-inflammatory painkillers or aspirin. Keep your fluids up. Do not assume you are better just because the fever has gone. And go straight to hospital for severe abdominal pain, bleeding, repeated vomiting, faintness, or reduced baby movements.

Dengue in pregnancy is serious, and it is also very manageable when it is caught early. Coming in promptly is what makes the difference.

See also our guides to a healthy early pregnancy and preparing for delivery.

References

  1. Ministry of Health, Sri Lanka. Guidelines for clinical management of dengue infection in pregnancy. Colombo: Epidemiology Unit, in collaboration with SLMA, SLCOG and CCP; 2019. Available from: https://www.epid.gov.lk/storage/post/pdfs/clinicalmanagementofdengueinfectioninpregnancy.pdf
  2. World Health Organization. Dengue and severe dengue [Internet]. Geneva: WHO; [cited 2026 Jul 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
  3. National Dengue Control Unit, Ministry of Health, Sri Lanka [Internet]. [cited 2026 Jul 22]. Available from: https://www.dengue.health.gov.lk/
  4. World Health Organization. Dengue vaccines: questions and answers [Internet]. Geneva: WHO; [cited 2026 Jul 22]. Available from: https://www.who.int/news-room/questions-and-answers/item/dengue-vaccines
  5. National Health Service. Dengue [Internet]. NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/conditions/dengue/