Infectious Diseases In Pregnancy Research Articles

1071 Marked 21-year decline in infectious diseases in pregnancy at the busiest maternity hospital in Europe

1071 Marked 21-year decline in infectious diseases in pregnancy at the busiest maternity hospital in Europe

Vaccination during pregnancy: A golden opportunity to embrace.

Immunization strategies are part of routine pregnancy care to prevent infectious diseases in the mother, the fetus, and the newborn. Maternal immunization recommendations followed the recognition of the consequences of infectious diseases in pregnancy, including vertical transmission and perinatal consequences. The recent COVID-19 pandemic highlighted the issue of vaccination among pregnant individuals. Recommendations vary globally; however, Tdap, influenza, and, recently, COVID-19 vaccines are routinely recommended during pregnancy. There are several new maternal immunization products in the pipeline, including those directed against malaria, cytomegalovirus, Group B Streptococcus, herpes simplex virus, and respiratory syncytial virus. Important challenges must be addressed in all countries to guarantee that pregnant individuals and their babies receive the best care possible, including uptake of recommended immunizations by their entire target population groups. These challenges include disseminating appropriate data for vaccine recommendations and many others, such as ensuring stakeholder endorsement, achieving in-country distribution and administration, adequate vaccine supply, and a well-organized healthcare system, ideally offering the immunization free of charge. More recently, the hesitancy of pregnant women to receive immunizations highlights the relevance of cultural aspects and other contextual factors affecting vaccine uptake among pregnant individuals.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

Listeriosis in pregnancy: An umbrella review of maternal exposure, treatment and neonatal complications.

Listeria monocytogenes is a commonly found organism in processed and prepared food and the disease of listeriosis is associated with a high morbidity and mortality. Compared with the general population, the risk of being diagnosed with listeriosis increases during pregnancy. Listeriosis can lead to miscarriage, spontaneous preterm labour and preterm birth, stillbirth and congenital neonatal infections. We conducted a universal review of listeriosis in pregnancy and in the newborn. The EMBASE, PubMed, Cinahl and Web of Science databases were searched for systematic reviews indexed before 1 December 2020. Any systematic reviews evaluating the prevalence, treatment, diagnosis and effects of listeriosis during pregnancy and up to 4weeks postnatally were included. Eligibility assessment, data extraction and quality assessment by the Methodological Quality Assessment of Systematic Reviews (AMSTAR-2) were performed in duplicate. We identified 397 citations of which nine systematic reviews comprising 330 studies and 487 patients' reviews were included. Most systematic reviews (seven of nine) were of moderate to high quality. Prevention in pregnant women was based on adherence to strict dietary recommendations, such as reheating leftovers until steamed and avoiding unpasteurised dairy products. Listeriosis infections were likely to occur in the third trimester (66%) rather than in the first trimester (3%) of pregnancy. Symptoms are mostly fever and other flu-like symptoms, such as fatigue. Diagnosis was primarily made by culture of the pathogen. Intravenous amoxicillin or ampicillin were first-line treatment. Listeriosis, a rare but serious infectious disease in pregnancy, can cause devastating consequences for the fetus and newborn. Appropriate preventative treatment should be initiated during early pregnancy to avoid complications. Listeria is commonly found in processed and prepared food. Prevention is the best way to avoid listeriosis during pregnancy.

Acceptance of vaccines during pregnancy during the COVID-19 pandemic

To evaluate patient acceptance of standard vaccines against infectious diseases in pregnancy - Tetanus, Diphtheria and Pertussis (Tdap) and influenza (flu) - during the COVID-19 pandemic compared to historical controls.

Primary toxoplasmosis acquired during early pregnancy: Is it currently overestimated?

ObjectiveToxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study. Study designWe retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999–2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP). Results237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%–2.61%)], 0% [0/178 (95% CI 0%–2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%–14.53%)] in CAIP group. ConclusionsToxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable.

Incidence of concomitant illnesses in pregnancy in Indonesia: Estimates from 1990–2019, with projections to 2030

SummaryBackground‘Indirect’ causes of maternal death including concomitant illnesses such as infectious and non-communicable diseases (NCDs), accounted for 23% of maternal deaths in Indonesia in 2010. Reproductive-age women in Indonesia face a “double burden” of disease with increasing rates of NCDs and persisting rates of infectious disease. However, there is a lack of data on the burden of these diseases in pregnancy. The aim of this study was to estimate incidence of concomitant illnesses among pregnant women in Indonesia from 1990–2030.MethodsPublicly available data was accessed including incidence of concomitant illnesses in Indonesian reproductive-age women, population data and crude birth rate data from 1990–2019, and formed basis for projections to 2030. A dataset of estimates for all variables was generated for each year and sampled from a binomial distribution. Using these estimates, pregnancy estimates and incidence in pregnant women were calculated. A cubic splines model was fitted to generate estimates of incidence of concomitant illnesses in pregnancy.FindingsPast trends to 2019 show a decline in incident cases of infectious diseases except for HIV/AIDs, and an increase in most NCDs. In 2019, the most common disease was sexually transmitted infections. From 2020–2030, incidences of diabetes and lower respiratory infections are estimated to continue to increase.InterpretationWith an increasing incidence of NCDs and high-incidence of infectious diseases in pregnancy, Indonesian policymakers and stakeholders should consider what evidence-based strategies and interventions are best to reduce potential impacts of concomitant illnesses on pregnancy outcomes.FundingAustralian Government Research Training Program Scholarship.

Emerging Infectious Diseases in Pregnant Women in a Non-Endemic Area: Almost One Out of Four Is at Risk.

We report the results of a targeted testing strategy for five emerging infectious diseases (Chagas disease, human T-lymphotropic virus 1 infection, malaria, schistosomiasis, and Zika virus infection) in pregnant women accessing an Italian referral centre for infectious diseases in pregnancy for unrelated reasons. The strategy is based on a quick five-question questionnaire which allows the identification of pregnant women at risk who should be tested for a specific disease. One hundred and three (24%) out of 429 pregnant women evaluated in a 20 month period were at risk for at least one emerging infectious disease. Three (2.9%, all from sub-Saharan Africa) out of 103 at-risk women resulted in being affected (one case of Plasmodium falciparum malaria, two cases of schistosomiasis) and were appropriately managed. Prevalence of emerging infectious disease was particularly high in pregnant women from Africa (three out of 25 pregnant women tested, 12%). The proposed strategy could be used by health care professionals managing pregnant women in non-endemic setting, to identify those at risk for one of the five infection which could benefit for a targeted test and treatment.

Screening for infectious disease in pregnancy.

Screening for infectious disease in pregnancy.

A predictive model to calculate the probability of placental abruption in patients with initially low obstetric risk

Aim. To develop a predictive model to calculate the probability of placental abruption development in patients with initially low obstetric risk by using a multidimensional mathematical analysis of anamnestic, clinical, and genetic data.&#x0D; Materials and methods. This logistic model is based on 212 observations. This study included two groups of healthy women aged 1835 years without a history of spontaneous abortion, preterm labor, stillbirth, preeclampsia, or other complications. The first group was comprised of 112 women with a history of a placental abruption (patient group), and the second group consisted of 100 women with non-complicated pregnancy (control group). Gene polymorphisms were detected using the polymerase chain reaction-real time technique. The data was analyzed using binary and multifactorial statistical mathematics. Our analysis of the predictive models was performed by using logistic regression. To determine the diagnostic value of the predictive models used, the ROC-curve is followed by determining the area under it (AUC).&#x0D; Results. The 24 anamnestic, clinical, and genotypic characteristics were examined as placental abruption predictors using multifactorial analysis. We were able to determine what the nine most informative predictors of placental abruption were according to Wald Chi-Square criteria (2, р): fetal growth restriction (13.143; р0.001), placental insufficiency (9.629; р=0.002), male sex of the fetus (6.965; р=0.008), preeclampsia (6.779; р=0.009), combination of genotypes PAI-1-5G4G/FV-1691GA (6.613; р=0.010) or PAI-1-5G4G/MTHFR-677CT (6.158; р=0.013), pathology of amnion (4.497; р=0.034), infectious diseases in pregnancy (4.277; р=0.039), tobacco smoking (3.963; р=0.047). ROC analysis identified a high specificity (82.64%) and sensitivity (77.42%) of the model, and the integral index of the effectiveness of predictive markers (AUC=0.836), according to the expert scale of values which is indicative of a very high quality model.&#x0D; Conclusion. It is recommended to use this elaborated predictive model in clinical practice for the purpose of individual risk assessment of placental abruption in healthy patients with initially low obstetric risk.

Management of Patients in the Context of Zika Virus: ACOG COMMITTEE OPINION SUMMARY, Number 784.

Zika virus is a flavivirus with the potential to cause serious adverse pregnancy and infant outcomes. Although rates of Zika virus infection have decreased in the United States, obstetrician-gynecologists and other health care providers should continue to assess their patients for potential exposure based on travel or sexual history and test symptomatic patients with possible exposure and pregnant women with ongoing exposure regardless of symptoms in accordance with the Centers for Disease Control and Prevention recommendations. Pregnant women and those planning a pregnancy should talk to their health care providers about potential risks before traveling to an area where current or past Zika virus transmission has occurred. Testing recommendations for pregnant women with possible Zika virus exposure differ based on the presence or absence of symptoms of Zika virus infection and the circumstances of possible exposure. If obstetrician-gynecologists or other health care providers identify a patient who has possibly been exposed to the Zika virus and may require testing, they should contact their local or state health department for assistance. Consultation with a maternal-fetal medicine specialist or an infectious disease specialist with expertise in the management of infectious diseases in pregnancy may be useful for pregnant women with possible maternal Zika virus infection or concerning fetal findings. Zika virus identification and follow-up care of infants born to women with possible exposure to Zika virus during pregnancy are critical and can ensure that appropriate intervention services are available to affected infants. Obstetrician-gynecologists and other obstetric care providers should have a system to ensure relevant information regarding a woman's Zika infection status is communicated to pediatric care providers.

Management of Patients in the Context of Zika Virus: ACOG COMMITTEE OPINION, Number 784.

Zika virus is a flavivirus with the potential to cause serious adverse pregnancy and infant outcomes. Although rates of Zika virus infection have decreased in the United States, obstetrician-gynecologists and other health care providers should continue to assess their patients for potential exposure based on travel or sexual history and test symptomatic patients with possible exposure and pregnant women with ongoing exposure regardless of symptoms in accordance with the Centers for Disease Control and Prevention recommendations. Pregnant women and those planning a pregnancy should talk to their health care providers about potential risks before traveling to an area where current or past Zika virus transmission has occurred. Testing recommendations for pregnant women with possible Zika virus exposure differ based on the presence or absence of symptoms of Zika virus infection and the circumstances of possible exposure. If obstetrician-gynecologists or other health care providers identify a patient who has possibly been exposed to the Zika virus and may require testing, they should contact their local or state health department for assistance. Consultation with a maternal-fetal medicine specialist or an infectious disease specialist with expertise in the management of infectious diseases in pregnancy may be useful for pregnant women with possible maternal Zika virus infection or concerning fetal findings. Zika virus identification and follow-up care of infants born to women with possible exposure to Zika virus during pregnancy are critical and can ensure that appropriate intervention services are available to affected infants. Obstetrician-gynecologists and other obstetric care providers should have a system to ensure relevant information regarding a woman's Zika infection status is communicated to pediatric care providers.

English

Urinary Tract Infection (UTI) is one of the commonest infectious disease in pregnancy, and in pregnancy we have very limited number of antibiotics to treat the UTI. This study was conducted on 151 patients who attended the gynecology clinic during the study period. Nineteen UTI proven cases of UTI were studied for prevalence of microorganism and sensitivity pattern against different antibiotics. Among the bacteria isolated, Escherichia coli (73.68%) and Staphylococcus aureus (10.52%) were the most prevalent Gram negative and Gram positive bacteria respectively. To know the resistance pattern of microorganism we used commercially available discs of different antibiotics. Gram negative bacteria showed more resistance as compared to Gram positive one. It is observed that the most effective antibiotic for Gram negative isolates is Ceftriaxone (87.5%), followed by Amoxicillin + Clavulanic acid (81.25%), Amikacin (75%), Cefuroxime (75%), Cefixime (68.75%) and Mezlocillin (62.5%). For the Gram positive bacteria, Ceftriaxone, Amikacin and Amoxicillin + Clavulanic acid were the most effective antimicrobials (100%). Multidrug resistance Gram negative bacteria were also tested for Extended-spectrum Beta Lactamase (ESBL), 35.71% of E. coli isolates were ESBL producer. Key words: Urinary tract infection, pregnancy, drug resistance, uropathogens, extended spectrum β-lactamase.

Determinants of Periodontal Disease in Pregnancy in an Urban Setting in Zimbabwe

Periodontal disease is one of the most common infectious diseases in pregnancy. The disease is caused by bacteria that produce inflammation of gingiva through production of inflammatory mediators that may have direct insult on amnion. Untreated and chronic dental infections have a possibility of causing harm to both the mother and the baby. This was an analytical cross-sectional study the purpose of which was to determine the prevalence and risk factors for periodontal disease in pregnancy. The study was conducted on a random sample of 350 postnatal mothers at Harare city Primary Care clinics. Study approval was granted by the Joint Research Ethics Committee of the University of Zimbabwe, College of Health Sciences and Parirenyatwa Group of Hospitals (JREC), the Medical Research Council of Zimbabwe (MRCZ) and Harare City Directorate. All participants gave informed consent. Code numbers were used to identify participants and interviews and oral assessments were conducted in private rooms. Data was collected through face to face interviews following a structured questionnaire, clinical intraoral examination and from clinical records. Data was captured using research electronic data capturing (RedCap) and was analyzed using the Statistical Package for Social Sciences (SPSS). Mean maternal age was 25.9 years, SD 5.7. prevalence of periodontal disease was 48.7%. No significant factors were associated with periodontal disease in the current study. However, other studies have reported significant risk factors for periodontal disease such as gestation age of the pregnancy and place of residence periodontal disease was significantly associated with the following birth outcomes. Periodontal health is the relatively neglected area in perinatal care. Health care professionals should be trained in screening for periodontal disease and giving health education in order to reduce adverse perinatal outcomes.

Common infectious diseases in pregnancy and its impact on perinatal outcome: A prospective study

Common infectious diseases in pregnancy and its impact on perinatal outcome: A prospective study

Epidemiology, management and outcome of varicella in pregnancy: a 20-year experience at the Tuscany Reference Centre for Infectious Diseases in Pregnancy.

Data from 215 pregnant women exposed to varicella and 276 with varicella observed at the Tuscany Reference Center for Infectious Diseases in Pregnancy, Florence, Italy, in the period 1997-2016 were retrospectively collected. The risk of developing varicella was lower in exposed women who received varicella zoster immunoglobulin compared with those who did not receive it [42% (21 of 50) vs 72% (13 of 18); p = 0.0263]. Typical congenital varicella syndrome was observed in 1.56% of fetuses/neonates born from pregnant women with varicella.

Causes of Stunting and Preventive Dietary Interventions in Pregnancy and Early Childhood.

Stunting of linear growth, a highly prevalent problem in children of low- and middle-income countries, is the result of the exposure of the fetus and/or young child to nutritional deficiencies and infectious diseases. Maternal undernutrition results in fetal growth restriction, and infectious diseases in pregnancy can result in preterm delivery. Both of these conditions are important contributors to stunting in early childhood, albeit their relative contribution varies by world region. After birth, growth faltering may begin at 3-5 months of life and becomes more prominent from 6 to 18 months. During this time, the young child is exposed to many infectious diseases, such as diarrhea, that have an adverse effect on growth. There is also increasing evidence that frequent ingestion of microorganisms results in damage to the small intestine. The resulting condition, referred to as environmental enteric dysfunction, even without clinical symptoms, may cause growth faltering. The complementary foods that the child receives in addition to breast milk are often inadequate in nutrients and energy, negatively affecting growth. Harmful exposure during pregnancy and the first 2 years of life, a critical period for growth and development, has led to a programmatic focus on this "1,000 days" in the life cycle. Dietary interventions, including nutrition education and for undernourished women provision of food supplements during pregnancy, result in improvements in fetal growth that position the newborn for healthier growth. Interventions in the first 2 years of life include promotion of exclusive breastfeeding for the first 6 months of life and continued breastfeeding for at least the first 2 years, nutritional counseling to assure adequate complementary feeding, and, if necessary in food insecure areas, the provision of supplemental food to be given to the child. Evidence shows that each of the interventions has a beneficial effect on the growth of the young child, yet that the effect is modest in relation to the degree of stunting observed in these underprivileged populations. Nevertheless, in recent years, reductions in the prevalence of stunting in some low-income countries show that substantial improvements are possible as a result of socioeconomic changes along with specific infection control and dietary interventions.

P249 Audit of adherence to referral pathway for pregnant women with history of genital herpes booked at a tertiary referral maternity hospital, aug 2015 – aug 2016

IntroductionGenital Herpes Simplex Virus (HSV) can be transmitted in the perinatal period with the potential for serious and devastating consequences for the fetus/infant. Transmission from mother to infant most commonly occurs due to exposure during delivery (85 – 90%). Early 2014, the team caring for women with Infectious Diseases in pregnancy identified that women, with a history of genital HSV or an outbreak in pregnancy, were an at-risk group without a specific care pathway, often with differing clinical decisions regarding their care.MethodsA retrospective audit was undertaken to ascertain adherence to a newly introduced referral pathway for pregnant women who gave a history of genital herpes booking into a tertiary referral Maternity Hospital, August 2015 – August 2016.ResultsOur initial audit over a 9 month period demonstrated that there was an overall deficit in knowledge regarding the new referral pathway. The 9 month audit showed that only 13 of 49 (26%) of women were referred to specialist services at any time during their pregnancy. Our subsequent audit showed 54% of women were referred for specialist consult in the period following re-education; a large improvement in awareness of our referral pathway.DiscussionAudit of practice and in particular following an introduction of a new care pathway, is an essential tool for demonstrating compliance as well as highlighting gaps which require addressing. Education targeting the team of midwives who ascertain women’s history on booking into the maternity services, has improved referrals as per our 4 month follow-up audit.

Emerging Infectious Diseases in Pregnancy.

It has been recognized for centuries that pregnant women have unique susceptibilities to many infectious diseases that predispose them to untoward outcomes compared with the general adult population. It is thought a combination of adaptive alterations in immunity to allow for the fetal allograft combined with changes in anatomy and physiology accompanying pregnancy underlie these susceptibilities. Emerging infectious diseases are defined as those whose incidence in humans has increased in the past two decades or threaten to increase in the near future. The past decade alone has witnessed many such outbreaks, each with its own unique implications for pregnant women and their unborn fetuses as well as lessons for the health care community regarding response and mitigation. Examples of such outbreaks include, but are not limited to, severe acute respiratory syndrome, the 2009 H1N1 pandemic influenza, Ebola virus, and, most recently, the Zika virus. Although each emerging pathogen has unique features requiring specific considerations, there are many underlying principles that are shared in the recognition, communication, and mitigation of such infectious outbreaks. Some of these key principles include disease-specific delineation of transmission dynamics, understanding of pathogen-specific effects on both mothers and fetuses, and advance planning and contemporaneous management that prioritize communication among public health experts, clinicians, and patients. The productive and effective working collaboration among the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine has been a key partnership in the successful communication and management of such outbreaks for women's health care providers and patients alike. Going forward, the knowledge gained over the past decade will undoubtedly continue to inform future responses and will serve to optimize the education and care given to pregnant women in the face of current and future emerging infectious disease outbreaks.

Immunoglobulin M indirect-fluorescent antibody test for the diagnosis of acute toxoplasmosis during pregnancy in the avidity era: A 14-year experience at the Tuscany Reference Center for Infectious Diseases in Pregnancy, Florence, Italy.

The aim of this study was to evaluate immunoglobulin M indirect-fluorescent antibody test (IgM IFAT) for the diagnosis of acute or chronic Toxoplasma infection in pregnancy. Pregnant women with suspected acute toxoplasmosis referred to the Tuscany Reference Center for Infectious Diseases in Pregnancy during the period 1998-2012 were retrospectively enrolled. All women were tested with a panel of serological tests, including enzyme-linked immunosorbent assay for IgG avidity and IgM IFAT. On the basis of anamnestic, clinical, and serological criteria, pregnant women were classified into three groups: recently infected (RI), latently infected (LI), and doubtful latently infected (DLI). Patients classified as DLI were excluded from the analysis. The association between IgM IFAT (positive or negative) and the diagnosis of infection (acute or chronic) was assessed. Positive predictive value and negative predictive value of the IgM IFAT were calculated. A total of 810 pregnant women were enrolled in the study: 302 in the RI group and 508 in the LI group. Fifty-two women classified as DLI were excluded. IgM IFAT was positive in 172 out of 302 (56.9%) pregnant women in the RI group and in 29 out of 508 (5.7%) in the LI group. The positive predictive value and negative predictive value of IgM IFAT in predicting RI was 85.6% and 78.6%, respectively. IgM IFAT has reasonable sensitivity and specificity in diagnosing recent infection and, mostly in case of borderline avidity test, could be considered as a further aid for an accurate diagnosis of acute toxoplasmosis in pregnancy.