Women's Health and Education Center (WHEC)

Infectious Diseases in Pregnancy

List of Articles

  • Hepatitis C Virus Infection and Pregnancy
    Hepatitis C virus (HCV) infection has been called a silent epidemic, because after infection, many individuals are unrecognized and untreated until years later. The review describes the prevalence of HCV infection during pregnancy, evaluate current risk factors associated with HCV antibody positivity, and identify novel composite risk factors for identification of groups most likely to demonstrate HCV antibody seropositivity in an obstetric population. It has been shown that infants born to HCV-positive women are more likely to have low birth-weight, be small for gestational age, be admitted to the intensive care unit, or require assisted ventilation. Universal HCV screening during the pregnancy is a fair, realistic, strategy which should be implemented in healthcare systems worldwide. In this review, we have also provided an up-to-date overview of the existing evidence on the pediatric use of direct-acting antivirals (DAAs), summarizing indications to treatment and recommendations for monitoring.

  • Novel Coronavirus (COVID-19) Disease and Pregnancy
    Novel coronavirus (COVID-19) is an emerging, rapidly evolving situation. The Women’s Health and Education Center's (WHEC's) publications in collaboration with the United Nations (UN) and the World Health Organization (WHO) will provide updated information as it becomes available. All individuals, including pregnant individuals, are encouraged to take precautions to avoid exposure to COVID-19 as the pandemic evolves. Pregnant women admitted with suspected COVID-19 or who develop symptoms suggestive of COVID-19 during admission should be prioritized for testing. Mother-to-child transmission of COVID-19 during pregnancy is unlikely, but after birth a newborn is susceptible to person-to-person spread. The mode of delivery should be individualized and based on a woman's preferences alongside obstetric indications. Cesarean sections should only be performed when medically justified. In limited studies COVID-19 has not been detected in breast milk. As the situation evolves, this document may be updated or supplemented to incorporate new data and relevant information.

  • Zika Virus Infection in Pregnancy
    Zika virus infection in humans appears to have changed in character while expanding in geographical range. Zika virus has now been clearly established as the cause of severe fetal malformations, particularly microcephaly. The risk of fetal injury appears to be greater when maternal infection occurs in the first trimester of pregnancy. Zika virus has now been established as the cause of Guillain-Barré syndrome (GBS) in adults. Although most cases of Zika virus infection are transmitted as the result of mosquito bites, patients can acquire the infection through sexual contact. Both male-to-female and female-to-male transmission have been documented. Currently, real-time reverse transcription polymerase chain reaction (rRT-PCR), immunoglobulin M (IgM), and plaque reduction neutralization (PRNT) tests are available to detect Zika infection, although each test has limitations. If a patient has had symptoms of Zika virus infection for less than 5 days, serum and urine should be obtained for rRT-PCR testing. If symptoms have been present for 5 to 14 days, urine should be tested by rRT-PCR because urine samples appear to remain positive for virus longer than serum samples do. Early-stage trials examine whether an experimental vaccine is safe and generates immune responses in vaccinated volunteers. A safe and effective, fully licensed Zika vaccine will likely not be available for several years.

  • Ebola Virus Disease and Pregnancy
    The review provides general background information on Ebola virus disease (EVD) and specifically addresses what is known about EVD in pregnancy and the implications for practicing obstetricians and gynecologists. Limited evidence suggests that pregnant women are at increased risk for severe illness and death when infected with Ebola virus, but there is no evidence to suggest that pregnant women are more susceptible to EVD. It is important that all health care providers are prepared to respond to ensure that Ebola virus transmission is contained. Specifically, U.S. health care providers, including obstetricians and gynecologists, should ask patients about recent travel to affected countries in West Africa, know the signs and symptoms of EVD, and know what to do if they have a patient with compatible illness. For all healthcare providers, infection-control procedures are recommended, including standard, contact, and droplet precautions. Pregnant women with EVD appear to be at an increased risk for spontaneous abortion and pregnancy-associated hemorrhage. Neonates born to mothers with EVD have not survived.

  • Preventing Mother-to-Child Human Immunodeficiency Virus Transmission
    Human immunodeficiency virus (HIV) is a scourge which continues to fatally wound the physical, cultural, social, economic, political, and spiritual health achievements, hopes and aspirations of individuals, families, communities and nations. This review describes the utility of antenatal surveillance for monitoring and evaluating prevention of mother-to-child HIV transmission programs in resource limited countries and generalized HIV epidemics. Population-based data sources regarding the incidence and morbidity that are associated with perinatal HIV infection are improving and indicate that prevention efforts have been enormously successful. There have been major advances with the prevention of mother-to-child HIV transmission, and this review summarizes the successes and current challenges and provides suggestions for future directions. Viewing preventing the mother-to-child transmission as a gateway to family-based HIV care and treatment will help strengthen ties between these programs. Site-specific interventions to increase the uptake of prevention of mother-to-child transmission programs based on experiences in sub-Saharan Africa are discussed. Lessons learned can apply to many resource-constrained settings.

  • Group B Streptococci Perinatal Infections: A Comprehensive Review
    Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection. In 2002, new national guidelines were released recommending: 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. In the pre-prevention era, active surveillance for invasive neonatal GBS disease estimated that approximately 6,100 early-onset cases and 1,400 late-onset cases occurred annually in the United States.  The purpose of this document is to address clinical issues of group B streptococci (GBS) perinatal infection, implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth-weight infants, emergence of resistant organisms and vaccine development.

  • Syphilis in Pregnancy: Prevention of Congenital Syphilis
    The purpose of this document is offers recommendations for treating infants and adults. It will also high-light the need to view syphilis screening and control programs through the perspectives of multiple stakeholders so as to identify barriers to, and opportunities for improving the formulation and implementation of national policies. Devising an effective political strategy might represent one of the most challenging facets of implementing a sustainable program. Both structured and unstructured approaches are useful, and applying aspects of both may provide rich analysis of why an intervention like antenatal syphilis screening is not being implemented. In USA a record low incidence of congenital syphilis, 20.6 cases per 100,000 live births, was recorded in 1998 by the Centers for Disease Control and Prevention (CDC) (1999a), resulting in creation of the National Plan for Syphilis Elimination.

  • Perinatal Viral Infections
    Many viral infections are associated with significant maternal and fetal consequences if acquired during pregnancy. In the United States, some the most commonly encountered infections with subsequent perinatal effects include cytomegalovirus (CMV), parvovirus B19 (fifth disease), varicella zoster virus (VZV). The purpose of this document is to describe these infections, their mode of transmission, and their maternal and fetal effects. Guidelines for counseling about and management of these infections during pregnancy are also discussed. In general, perinatal infections have more severe fetal consequences when they occur early in gestation, because first-trimester infections may disrupt organogenesis. Second and third trimester infections can cause neurologic impairment or growth restriction.

  • Genital Herpes Simplex Virus Infection during Pregnancy
    Herpes simplex virus (HSV) infection of the genital tract is one of the most common viral sexually transmitted diseases (STDs). Approximately 45 million adolescent and adult Americans have been infected with genital herpes based on positive serology test results for HSV-2 and estimates of genital HSV-1 infection. About 30% of the female population in the United States has antibodies to HSV-2. The purpose of this document is to define the stages of herpetic infection, outline the spectrum of maternal and neonatal infection and provide the management guidelines.

  • Toxoplasmosis: Perinatal Parasitic Infection
    Toxoplasmosis is caused by the intracellular parasite Toxoplasma gondii. The purpose of this document is to describe the mode of transmission of toxoplasmosis, the maternal and fetal effects, and to offer guidelines for counseling and management during pregnancy. Parasitic infections are associated with significant maternal and fetal consequences if acquired during pregnancy. Congenital toxoplasmosis and prevention are also discussed in this review. Pregnant women who acquire toxoplasmosis should be treated. Treatment of the pregnant women with acute toxoplasmosis reduces but does not eliminate the risk of congenital infection.

  • Viral Hepatitis in Pregnancy
    Viral hepatitis complicates 0.2% of all pregnancies. It is one of the most serious infections that can occur in pregnant women. Six different forms of viral hepatitis have now been defined. The most common viral agents causing hepatitis in pregnancy are hepatitis A virus, hepatitis B virus, hepatitis C (non-A, non-B hepatitis virus), and Epstein-Barr virus. Delta agent hepatitis has also received increasing attention as a cause of hepatitis. This chapter addresses various types of hepatitis, their implications during pregnancy, the risk of perinatal transmission and treatment. The immunization recommendations of the Centers for Disease Control and Prevention (CDC) are also discussed with special focus on health care workers.

  • HIV in Pregnancy: A Comprehensive Review
    The transformation of the human immunodeficiency virus (HIV) epidemic over the last 20 years has been remarkable. With access to appropriate therapies, clinicians can now offer infected women a much improved prognosis as well as a very high likelihood of birthing children who will be HIV uninfected. Prevention of transmission of HIV from mother to fetus or newborn (vertical transmission) is a major goal in the care of pregnant women infected with HIV. In this article, the most recent developments in the field are summarized in a fashion that should allow the integration into the practice of obstetrics and thereby assure the HIV-infected women the best possible prognosis for themselves and for their children. The focus of this work is on the dual responsibilities of obstetricians, assuring the health of women and minimizing the risks of transmission.

  • H1N1 Influenza in Pregnancy
    This document provides review of novel influenza A (H1N1) virus infection in pregnant women. Pregnant women with confirmed, probable, or suspected influenza A (H1N1) virus infection should receive antiviral treatment. Given the potential for rapidly worsening disease, close follow-up is recommended. The healthcare provider prescribing treatment should plan to contact patients on treatment within the first 24 hours of therapy to evaluate response. This review adds to a growing body of data that supports the notion that pregnant women may be both susceptible to and exhibit more severe symptoms with H1N1 influenza than is seen in non-pregnant patients.

  • Community Acquired Pneumonia in Pregnancy
    Although morbidity and mortality from pneumonia has decreased since 1901, pneumonia in pregnancy remains a major health issue worldwide. Pneumonia classification includes: community acquired pneumonia (CAP) encountered in otherwise healthy individuals, health care-associated pneumonia (HCAP) developing in outpatient-care facilities, hospital-acquired pneumonia, nursing-home-acquired pneumonia, and ventilator-associated pneumonia. Improving the care of adult patients with CAP has been the focus of many different organizations, and several have developed guidelines for management of CAP.  Recent recommendations by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) on the management of CAP address diagnostic techniques and management schemes for bacterial and viral pneumonias are addressed. These guidelines are discussed in the setting of the pregnant woman with CAP. It is widely held that pregnant women do not tolerate lung infections as well, and thus pneumonia can result in greater morbidity and mortality. Because of this, most recommend that a higher level of surveillance and intervention be practiced for the pregnant women.

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