Susceptibility and severity of infections in pregnancy: Difference between revisions

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In [[pregnancy]], there is an '''increased susceptibility and/or severity of several [[infection|infectious diseases]]'''.
{{Short description|Overview of infection susceptibility and severity during pregnancy}}


==General determinants==
==Overview==
There are several potential risk factors or causes to this increased risk:
Pregnancy is a unique physiological state that can alter a woman's immune system, making her more susceptible to certain infections and potentially affecting the severity of these infections. The immune system undergoes adaptations to tolerate the fetus, which is genetically distinct from the mother. These changes can influence the body's response to infectious agents.
*An increased [[immune tolerance in pregnancy]] to prevent an immune reaction against the fetus
*[[maternal physiological changes in pregnancy|Maternal physiological changes]] including a decrease in [[respiratory volume]]s and [[urinary stasis]] due to an enlarging uterus.<ref name="KourtisRead2014">{{cite journal|last1=Kourtis|first1=Athena P.|last2=Read|first2=Jennifer S.|last3=Jamieson|first3=Denise J.|title=Pregnancy and Infection|journal=New England Journal of Medicine|volume=370|issue=23|year=2014|pages=2211–2218|issn=0028-4793|doi=10.1056/NEJMra1213566|pmc=4459512}}</ref>
*The presence of a [[placenta]] for pathogens to use as a habitat, such as by ''[[Listeria monocytogenes|L. monocytogenes]]'' and ''[[P. falciparum]]''.<ref name="KourtisRead2014"/>


==Examples==
==Immune System Changes in Pregnancy==
Pregnant women are more severely affected by [[influenza]], [[hepatitis E]], [[herpes simplex]] and [[malaria]].<ref name="KourtisRead2014"/> The evidence is more limited for [[coccidioidomycosis]], [[measles]], [[smallpox]], and [[varicella]].<ref name="KourtisRead2014"/> Pregnancy may also increase susceptibility for [[toxoplasmosis]].<ref name=Jamieson>Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006 Nov. Available from https://www.cdc.gov/ncidod/EID/vol12no11/06-0152.htm</ref>
During pregnancy, the immune system shifts to accommodate the developing fetus. This involves a complex balance between immune tolerance and defense against pathogens. Key changes include:


{|class="wikitable"
* '''Hormonal Influences''': Increased levels of hormones such as progesterone and estrogen can modulate immune responses.
|+ Infections where pregnancy increases susceptibility
* '''Immune Cell Alterations''': There is a shift from a Th1-dominant response, which is pro-inflammatory, to a Th2-dominant response, which is anti-inflammatory. This helps in maintaining pregnancy but can reduce the ability to fight off certain infections.
! Infection !! Increased<br> susceptibility<ref name="KourtisRead2014"/> !! Increased<br> severity<ref name="KourtisRead2014"/> !! Prevention<ref name="KourtisRead2014"/> !! Management<ref name="KourtisRead2014"/>
* '''Increased Regulatory T Cells''': These cells help in maintaining tolerance to the fetus but may also suppress responses to infections.
|-
! [[Influenza]]
| No || Yes || [[Influenza prevention]]:
*[[Influenza vaccine|Vaccination]]
*Prophylactic [[influenza treatment]] for selected patients
|
*Early identification
*Early [[Influenza treatment]]
*Supportive care
|-
! [[Hepatitis E]]
| No || Yes ||
*Sanitation programs
|
*High index of clinical suspicion
*Supportive care
|-
! [[Herpes simplex]]
| No || Yes
| [[Safe sex]]
|
*High index of clinical suspicion
*Antiviral therapy
*Supportive care
*Care of the newborn
|-
! [[Malaria]]
| Yes || Yes || Intermittent preventive therapy:
*[[Mosquito control]]
*[[Malaria prophylaxis]] (for travelers)
|
*Early identification
*[[Antimalarial medication]]
*Supportive care
|-
! [[Listeriosis]]
| Yes || No ||
*Dietary guidance
|
*Early identification
*Antimicrobial therapy
*Care of the newborn
|-
! [[Measles]]
| No || Yes ||
* [[Measles vaccine]]
|
*High index of clinical suspicion
*Supportive care
|-
! [[Smallpox]]
| No || Yes ||
*[[Smallpox vaccine]]
|
*Very high index of clinical suspicion
*Supportive care
|-
! [[HIV/AIDS]]
| Yes || No ||
*[[Safe sex]]
|
* Early identification
* [[Management of HIV/AIDS|Antiretroviral]] therapy
|-
! [[Varicella]]
| No || Yes ||
*[[Varicella vaccine]]
|
* [[Chickenpox#Adults|Antiviral therapy]]
*Supportive care
|-
! [[Coccidioidomycosis]]
| No || Yes || No proven methods of prevention ||
*Early identification
*Antifungal therapy
|}


During the [[2009 H1N1 pandemic]], as well as during interpandemic periods, women in the [[third trimester]] of pregnancy were at increased risk for severe
==Common Infections in Pregnancy==
disease, such as disease requiring admission to an [[intensive care unit]] or resulting in death, as compared with women in an earlier stage of pregnancy.<ref name="KourtisRead2014"/>
Pregnant women are at increased risk for certain infections, which can have implications for both maternal and fetal health. Some common infections include:


For [[hepatitis E]], the case fatality rate among pregnant women has been estimated to be between 15% and 25%, as compared with a range of 0.5 to 4% in the population overall, with the highest susceptibility in the third trimester.<ref name="KourtisRead2014"/>
* '''[[Urinary Tract Infections]] (UTIs)''': More common due to anatomical and physiological changes in the urinary tract.
* '''[[Influenza]]''': Pregnant women are more susceptible to severe illness from influenza, which can lead to complications such as pneumonia.
* '''[[Listeriosis]]''': Caused by the bacterium Listeria monocytogenes, this infection can lead to severe outcomes for the fetus, including miscarriage or stillbirth.
* '''[[Toxoplasmosis]]''': Infection with Toxoplasma gondii can be transmitted to the fetus, potentially causing congenital toxoplasmosis.


Primary [[herpes simplex]] infection, when occurring in pregnant women, has an increased risk of dissemination and hepatitis, an otherwise rare complication in immunocompetent adults, particularly during the third trimester.<ref name="KourtisRead2014"/> Also, recurrences of [[herpes genitalis]] increase in
==Impact on Fetal Health==
frequency during pregnancy.<ref name="KourtisRead2014"/>
Infections during pregnancy can have significant effects on fetal development and outcomes. Potential impacts include:


The risk of severe [[malaria]] by ''[[Plasmodium falciparum]]'' is three times as high in pregnant women, with a median maternal mortality of 40% reported in studies in the Asia–Pacific region.<ref name="KourtisRead2014"/> In women where the pregnancy is not the first, malaria infection is more often asymptomatic, even at high parasite loads, compared to women having their first pregnancy.<ref name="KourtisRead2014"/> There is a decreasing susceptibility to malaria with increasing parity, probably due to immunity to pregnancy-specific [[antigens]].<ref name="KourtisRead2014"/> Young maternal age and increases the risk.<ref name="KourtisRead2014"/> Studies differ whether the risk is different in different [[wikt:trimester|trimesters]].<ref name="KourtisRead2014"/> Limited data suggest that malaria caused by ''[[Plasmodium vivax]]'' is also more severe during pregnancy.<ref name="KourtisRead2014"/>
* '''Congenital Infections''': Some infections can be transmitted from mother to fetus, leading to congenital conditions.
* '''Preterm Birth''': Infections can trigger preterm labor, leading to premature birth and associated complications.
* '''Developmental Issues''': Certain infections can affect fetal development, leading to long-term health issues.


Severe and disseminated [[coccidioidomycosis]] has been reported the occur in increased frequency in pregnant women in several reports and case series, but subsequent large surveys, with the overall risk being rather low.<ref name="KourtisRead2014"/>
==Prevention and Management==
Preventing and managing infections during pregnancy is crucial for maternal and fetal health. Strategies include:


[[Varicella]] occurs at an increased rate during pregnancy, but mortality is not higher than that among men and non-pregnant women.<ref name="KourtisRead2014"/>
* '''Vaccination''': Vaccines such as the influenza vaccine are recommended for pregnant women to reduce the risk of severe illness.
* '''Hygiene Practices''': Good hygiene can help prevent infections like listeriosis and toxoplasmosis.
* '''Regular Prenatal Care''': Regular check-ups can help in early detection and management of infections.


[[Listeriosis]] mostly occurs during the third trimester, with [[Hispanic]] women appearing to be at particular risk.<ref name="KourtisRead2014"/> Listeriosis is a [[vertically transmitted infection]] that may cause [[miscarriage]], [[stillbirth]], [[preterm birth]], or serious [[neonatal disease]].<ref name="KourtisRead2014"/>
==Conclusion==
Understanding the susceptibility and severity of infections during pregnancy is essential for healthcare providers to ensure the health and safety of both the mother and the developing fetus. Through appropriate preventive measures and timely management, the risks associated with infections can be significantly reduced.


Some infections are [[Vertically transmitted infection|vertically transmissible]], meaning that they can affect the child as well.
==Related pages==
* [[Pregnancy]]
* [[Immune system]]
* [[Infection]]
* [[Maternal health]]


==See also==
[[Category:Pregnancy]]
*[[Vertically transmitted infection]]
[[Category:Infectious diseases]]
 
[[Category:Maternal health]]
==References==
{{reflist}}
 
[[Category:Obstetrics]]
[[Category:Infections specific to the perinatal period]]
{{dictionary-stub1}}
{{No image}}

Latest revision as of 19:09, 22 March 2025

Overview of infection susceptibility and severity during pregnancy


Overview[edit]

Pregnancy is a unique physiological state that can alter a woman's immune system, making her more susceptible to certain infections and potentially affecting the severity of these infections. The immune system undergoes adaptations to tolerate the fetus, which is genetically distinct from the mother. These changes can influence the body's response to infectious agents.

Immune System Changes in Pregnancy[edit]

During pregnancy, the immune system shifts to accommodate the developing fetus. This involves a complex balance between immune tolerance and defense against pathogens. Key changes include:

  • Hormonal Influences: Increased levels of hormones such as progesterone and estrogen can modulate immune responses.
  • Immune Cell Alterations: There is a shift from a Th1-dominant response, which is pro-inflammatory, to a Th2-dominant response, which is anti-inflammatory. This helps in maintaining pregnancy but can reduce the ability to fight off certain infections.
  • Increased Regulatory T Cells: These cells help in maintaining tolerance to the fetus but may also suppress responses to infections.

Common Infections in Pregnancy[edit]

Pregnant women are at increased risk for certain infections, which can have implications for both maternal and fetal health. Some common infections include:

  • Urinary Tract Infections (UTIs): More common due to anatomical and physiological changes in the urinary tract.
  • Influenza: Pregnant women are more susceptible to severe illness from influenza, which can lead to complications such as pneumonia.
  • Listeriosis: Caused by the bacterium Listeria monocytogenes, this infection can lead to severe outcomes for the fetus, including miscarriage or stillbirth.
  • Toxoplasmosis: Infection with Toxoplasma gondii can be transmitted to the fetus, potentially causing congenital toxoplasmosis.

Impact on Fetal Health[edit]

Infections during pregnancy can have significant effects on fetal development and outcomes. Potential impacts include:

  • Congenital Infections: Some infections can be transmitted from mother to fetus, leading to congenital conditions.
  • Preterm Birth: Infections can trigger preterm labor, leading to premature birth and associated complications.
  • Developmental Issues: Certain infections can affect fetal development, leading to long-term health issues.

Prevention and Management[edit]

Preventing and managing infections during pregnancy is crucial for maternal and fetal health. Strategies include:

  • Vaccination: Vaccines such as the influenza vaccine are recommended for pregnant women to reduce the risk of severe illness.
  • Hygiene Practices: Good hygiene can help prevent infections like listeriosis and toxoplasmosis.
  • Regular Prenatal Care: Regular check-ups can help in early detection and management of infections.

Conclusion[edit]

Understanding the susceptibility and severity of infections during pregnancy is essential for healthcare providers to ensure the health and safety of both the mother and the developing fetus. Through appropriate preventive measures and timely management, the risks associated with infections can be significantly reduced.

Related pages[edit]

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