Managing Infections in Pregnancy

Yves Villel Marianne Leruez-Ville

Disclosures

Curr Opin Infect Dis. 2014;27(3):251-257. 

In This Article

Abstract and Introduction

Abstract

Purpose of review The management of infection in pregnancy aims mainly at improving the diagnosis and prognosis of congenital infections. Over 400 publications have dealt with this issue over the last 2 years, taking advantage of progress made not only in the epidemiological knowledge of infections but also neonatal treatment and prenatal diagnosis and interventions. The focus remains largely on viral and parasitic infections, namely cytomegalovirus (CMV) and toxoplasmosis, with the appearance of influenza as part of recent and severe outbreaks.

Recent findings The prevalence of CMV infection is stable. The prediction of foetal infection from primary maternal infection is becoming more accurate and therapeutic approaches are promising, including the development of a vaccine in the near future. The prevalence of toxoplasmosis is decreasing markedly in Europe weakening the effect of preventive measures and questioning the rationale for screening. In addition, the efficacy of prenatal treatment is still under scrutiny, although no appropriate randomized controlled trial (RCT) has been undertaken.

Summary Accurate dating of maternal primary infection is key to prenatal management including foetal and perinatal surveillance and therapy. Heightened prenatal surveillance following influenza infection in early pregnancy is warranted by an apparent increased risk of nonchromosomal congenital malformations in large epidemiological studies, likely as an effect of maternal hyperthermia.

Introduction

The infections under review in this article are maternal infections that may affect foetal development or well being. A Medline search for congenital infection and pregnancy covering from 2012 and up to March 2014 retrieved over 443 articles of which 25% deal with cytomegalovirus (CMV) infection, 25% with research on immunology of infection and vaccination and 15% with toxoplasmosis. In addition to the usual suspects, influenza has emerged as a concern in pregnancy with over 20 recent articles reporting the risk mainly in early pregnancy. We have excluded peripartum infections and their consequences with varicella, herpes simplex type II viruses, group B streptococcus and other bacteria responsible for preterm labour or preterm prelabour rupture of the membranes.

The three important levels to approach foetal infections are epidemiology and interpretation of maternal serologies and therefore dating of maternal infection, prenatal diagnostic and prognostic assessment and therapeutic possibilities.

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