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Infectious Diseases in Pregnancy

• Editor's Note
• List of Articles

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.
  
  

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