Minor infections during pregnancy are common due to the generalized suppression of maternal immunity. These are often resolved by a proper dosage of non-teratogenic antibiotics for the appropriate duration along with rest and a healthy diet. However, certain infections acquired during the first trimester have caused life-threatening consequences for the foetus and the mother both. Therefore, it is vital that these infections be recognized as early as possible so further damage can be mitigated. Additionally, it should be kept in mind that while some organisms cause minor infections in a healthy non-pregnant female, the same can have dangerous consequences on a pregnant female.
Causative Organisms and Diagnosis
Bacterial and viral agents constitute the majority of these infections. However, other parasites like fungi and protozoans can also contribute to the burden of the disease. In most developed countries, the most common modes of transmission include sexual intercourse or airborne vectors. Developing countries, on the other hand, witness a majority of these infections originating from water or food sources.
Diagnosis depends on the appearance of signs and symptoms typical of the causative agent, along with blood samples, urine culture, nasal swabs or ultrasonography, depending on the location affected by the organism. The recent COVID-19 outbreak has made rapid antigen testing and RTPCR familiar in terms of confirming a diagnosis.
Exercising caution becomes all the more important during pandemics as evident from the Coronavirus outbreaks. From January 22 to June 7, 2020, the CDC reported that pregnant women are at an increased risk of developing COVID-19 related complications including pneumonia, diarrhoea, and shortness of breath which increased the chances of hospitalization with ICU admissions and mechanical ventilation. However, these were not associated with an increased maternal or foetal mortality rate.
Another outbreak of the Zika Virus in 2016, transmitted by the daytime bite of the Aedes mosquito became a cause for concern rapidly due to the disastrous consequences found in the developing foetus. Microcephaly or underdeveloped foetal skull along with vision and musculoskeletal defects were recorded in neonates born to mothers with Zika Virus infection. Since there is no vaccine available, it is advised that women who are pregnant or are trying to get pregnant avoid travelling to areas inflicted by Zika, mostly in the Central African countries.
Jaundice is a common complication witnessed during pregnancy, particularly in the developing countries. Viral hepatitis is the main contributor towards it. Hepatitis A is the most common infection worldwide. Transmitted via faeco-oral and sexual routes, intrauterine and perinatal transmission of infection from mother to foetus is a rare event. Hepatitis B on the other hand is recorded to have caused the perinatal transmission to the foetus. However, it cannot cross the placenta.
Hepatitis C infection, similarly has been reported to cause perinatal transmission which occurs mostly during the last month of pregnancy or delivery. Hepatitis C is the leading cause of viral hepatitis in the newborn. Procedures like chorionic villi sampling or amniotic fluid sampling can breach the continuity of the placental membrane and increase the risk of vertical transmission from mother to foetus. Isolated Hepatitis D infection is rare as it requires viral particles of Hepatitis B surface antigen to cause infection.
However, co-infection of Hepatitis B and D is a fatal complication due to rapid progression to liver failure and hepatocellular carcinoma in the mother. Vaccination against Hepatitis B is the only way to prevent this severe complication of co-infection. Common symptoms of jaundice include nausea, vomiting, diarrhoea, fever, loss of appetite, dark urine, pale stools and sometimes severe itching in the palmar areas due to accumulation of inflammatory bile pigments in these areas.
Some bacterial infections are similarly disastrous when contracted during pregnancy. Group B streptococcus is one such entity. It causes pneumonia, bacterial meningitis and generalized life-threatening sepsis in both the mother and foetus. Regular screening is advised at 35-37weeks of gestation. IV Penicillin is the first line of treatment in case a positive blood or urine culture is reported during labour. Women with previous anaphylactic reactions to Penicillin can be administered with Cefazolin or Vancomycin.
TORCH infections deserve a special mention here. It stands for Toxoplasma, Other agents, Rubella, Cytomegalovirus and Herpes Simplex Virus. The group of these infections can cause severe disability in the foetus ranging from microcephaly, cataracts, musculoskeletal defects, stillbirths and miscarriages.
Suggestions and Recommendations for Infection Control
- Avoid contact with pet cats or stray cats as they harbour Toxoplasma gondii parasites.
- Get vaccinated against the Hepatitis B virus.
- Boil water and consume well-cooked food items to prevent infections from food-borne agents.
- Actively use mosquito repellents, Eucalyptus oil and mosquito nets to keep away from mosquito bites.
- Maintain intimate area hygiene and use clean toilets to prevent contraction of urinary tract infections.
- Use safe sex practices to keep sexually transmitted infections at bay which can often have disastrous consequences on both maternal and foetal health.