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Some common infections affect pregnant women differently and treatment options must be chosen keeping safety in pregnancy in mind.
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Certain infections can be transmitted vertically and pregnancies affected by these infections must be monitored and managed to decrease transmission.
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Some infections can be acquired in utero and can cause congenital infections in newborns that lead to developmental anomalies, affect growth, and lead to significant neonatal morbidity and mortality.
Infections During Pregnancy
Section snippets
Key points
Urinary Tract Infections
Recurrent bacteriuria and pyelonephritis are more common in pregnancy. Smooth muscle relaxation and dilation of ureters with pregnancy increases the propensity for ascending infection. Screening and treatment of urinary tract infections (UTIs) are more intensive in pregnancy than in the general population. Infectious Disease Society of America guidelines recommend universal screening of pregnant women for asymptomatic bacteriuria with urine culture in early pregnancy and periodic rescreening in
Organism and Epidemiology
Toxoplasma gondii is a protozoan parasite spread through cat feces, contaminated soil, or by consuming undercooked meats. T gondii preferentially invades neural tissues (brain and retina), skeletal muscle, and/or cardiac muscle forming cysts that destroy host cells.74 Approximately 201,000 cases of congenital toxoplasmosis are reported worldwide yearly with highest prevalence in tropical regions. Toxoplasmosis affects between 10 and 33/100,000 of live births in the United States.75 Risk of
Organism and Epidemiology
Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum. In 2016 there were 628 cases of congenital infection in the United States, rates being highest in the southern states and in minority populations.80 Lack of adequate prenatal care carries the highest risk of congenital infection.
Clinical Presentation
Syphilis infection manifests over time in several stages. Primary syphilis presents 3 to 6 weeks after exposure with painless chancres in the genital areas at the site of
Organism and Epidemiology
Rubella is a single-stranded RNA virus spread via inhalation of infected particles. Routine vaccination worldwide has led to a 95% decrease in cases from 2000 to 2014 and The Pan American Health Organization declaring rubella eliminated from the Americas in 2015. The US National Congenital Rubella Registry does report 5 to 6 cases of congenital infection yearly, primarily in infants of mothers who emigrated from countries without adequate vaccine programs. Risk of congenital rubella is highest
Organism and Epidemiology
CMV is the most common congenital viral infection, affecting up to 2% of live births.84, 85 In the United States, congenital CMV is the leading cause of long-term disabilities in children and is the most common cause of nonhereditary hearing loss worldwide.86 Risk of vertical transmission is between 30% and 40% for a primary infection; this risk increases with each trimester; however, more serious sequelae are typically seen with earlier infection.77
Clinical Presentation
Maternal infection with CMV is almost always
Organism and Epidemiology
HSV is a sexually transmitted, double-stranded DNA virus that exists as 2 distinct subtypes, HSV-1 and HSV-2. A common infection, the prevalence of HSV-1 is higher (54%) when compared with HSV-2 (16%) in the United States amongst all individuals aged 14 to 49 years.92 Despite a high prevalence, neonatal infections in the United States are uncommon occurring in around 1 out of every 3200 births.93 In utero transmission is even more rare at 1 in 300,000 births.94
Infection with HSV-1 or HSV-2 in a
Varicella-zoster virus and parvovirus B19
Varicella-zoster virus is sometimes included with TORCH infections. The annual incidence of infection during pregnancy is low (0.4–0.7/1000) due to high rates of natural and acquired immunity. Between 10% and 20% of women infected during pregnancy develop pneumonia with a mortality rate up to 40%.77 Manifestations of congenital varicella syndrome are shown in Box 6.103
ACOG recommends oral acyclovir for treatment because it may reduce morbidity and mortality in patients with pneumonia; however,
Organism and Epidemiology
Zika virus is a single-stranded RNA flavivirus transmitted to humans by Aedes mosquitoes. Person-to-person transmission is possible through sexual and mother-to-child transmission. Zika virus was first detected in the Western Hemisphere in 2014 and an outbreak has been ongoing in the Americas, Pacific, and Caribbean.104, 105, 106, 107 Between 2015 and February 2018, 5653 cases of symptomatic Zika virus have been reported in the United States with 95% of these in travelers to affected areas.108
Clinical Presentation
Discussion
Some infections are highlighted in pregnancy due to having unique effects on the mother-child dyad. Research often lags or is lacking on the effects of diseases and medications in pregnancy. Research is constantly evaluating ways to decrease risk of vertical transmission. Some novel treatments such as direct-acting antivirals for hepatitis C have not yet been studied in pregnancy and may provide new options. Infections, such as Zika virus, that can cause in utero infection are emerging and
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Cited by (32)
Gestational urinary tract infections and the risk of antenatal and postnatal depressive and anxiety symptoms: A longitudinal population-based study
2021, Journal of Psychosomatic ResearchCitation Excerpt :More than half of all women have at least one UTI in their lifetime [3]. Several anatomic, immunological, and physiological changes, including changes in the urinary tract, predispose pregnant women to UTIs and other types of infections [4,5]. Hence, UTI is common during gestation complicating up to 20% of pregnancies [2].
Placental pathology in women with HIV
2021, PlacentaCitation Excerpt :Recognizing the importance of placental features and their unique functions can provide crucial insight on the uterine environment during the course of pregnancy [5,6]. Maternal infections during pregnancy are known to have adverse effects on placental and fetal development, pregnancy outcomes and even impact neonatal health [5,7]. HIV in particular, causes severe immune dysregulation characterized by persistent inflammation and chronic immune activation [8].
Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus
2021, Biochimica et Biophysica Acta - Molecular Basis of DiseaseCitation Excerpt :After birth, infants should thus be tested within first days of life and then again . at 2–3 weeks of age, at 1–2 months of age and at 4–6 months of age [146]. All pregnant mothers should be screened for HIV in the first trimester: for infants born to mothers with unknown HIV status, a rapid HIV screening of mothers and/or infants should be performed as soon as possible, either during labor or after delivery, starting immediately the appropriate neonatal postexposure prophylaxis (PEP) if the test is positive [147].
Assembly of the virome in newborn human infants
2021, Current Opinion in VirologyCitation Excerpt :Early studies of microbial populations in placenta, meconium (the earliest stool of an infant), and amniotic fluid showed low and inconsistent recovery of culturable microbes [19–24], leading to the initial view that the womb is usually sterile in healthy pregnancies. Of course, there are many infections that can cross the placenta and harm the fetus, but these are characteristic of disease states and not health [25,26]. However, the hypothesis of a sterile healthy womb was challenged in recent years by studies using deep sequencing and other nucleic-acid based methods, which reported detection of microbes in placenta, amniotic fluid, and the fetus [27–31].
Pregnancy-induced hypertension: Role of drug therapy and nutrition in the management of hypertension
2021, PharmaNutritionCitation Excerpt :Clinical validation of pregnancy is done by the detection of hormone beta-human chorionic gonadotropin (beta-HCG) in blood and urine samples of pregnant women [23,24]. Further, various biochemical parameters like blood group, Rhesus type, thyroid function, blood glucose, and hemoglobin levels are monitored and infections including hepatitis B, HIV, syphilis, and rubella are also evaluated to determine any kind of complications associated with pregnancy [25,26]. First pregnancy ultrasound scan is recommended between 10–14 weeks of gestation.
Maternal Infection in Pregnancy and Childhood Leukemia: A Systematic Review and Meta-analysis
2020, Journal of Pediatrics
Disclosure: The authors have nothing to disclose.