Perinatal Infections: Silent Threats

Introduction

Perinatal infections are a significant public health concern, as they can result in serious morbidity and mortality for both the mother and the newborn. Perinatal infections can be caused by a wide range of pathogens, including viruses, bacteria, fungi, and parasites, and they can be acquired during pregnancy, labor, and delivery or after birth through breastfeeding or close contact with infected individuals. The consequences of perinatal infections can vary widely, from mild and self-limited illnesses to severe, life-threatening conditions such as sepsis, meningitis, pneumonia, and congenital anomalies. Therefore, timely diagnosis and appropriate management of perinatal infections are critical for improving maternal and neonatal outcomes.

How Are Perinatal Infections Transmitted From Mother to Fetus or Newborn?

Perinatal infections can be transmitted from a mother to fetus or newborn in several ways, including:

• In Utero Transmission: Some infections, such as HIV, syphilis, rubella, and Zika virus, can be transmitted from mother to fetus during pregnancy through the placenta.

• During Delivery: Infections such as group B Streptococcus (GBS), chlamydia, and gonorrhea can be passed from the mother to the infant during delivery through contact with infected fluids, such as blood or amniotic fluid.

• Through Breastfeeding: Certain infections, such as HIV and CMV, can be transmitted from mother to infant through breast milk.

What Are the Symptoms?

The symptoms of perinatal infections can vary depending on the type of infection and the timing of transmission. Some infections may not cause any symptoms in the mother or infant, while others can cause severe illness and complications. Here are some possible symptoms:

• Fever.

• Rash.

• Fatigue.

• Joint pain.

• Headache.

• Muscle aches.

• Swollen lymph nodes.

• Vaginal discharge or itching.

• Pain or burning during urination.

• Abdominal pain or cramping.

• Diarrhea.

• Jaundice (yellowing of the skin and eyes).

• Enlarged liver or spleen.

• Respiratory distress (difficulty breathing).

What Are the Long-Term Health Consequences of Perinatal Infections for Both Mother and Child?

Perinatal infections can have long-term health consequences for both the mother and child. Here are some examples:

For the Child:

1. Developmental delays.

2. Intellectual disability.

3. Vision problems.

4. Hearing loss.

5. Chronic infection.

6. Liver damage (in the case of hepatitis B or C).

7. Neurological complications (in the case of infections such as CMV or Zika virus).

For the Mother:

1. Increased risk of preterm labor and delivery.

2. Maternal sepsis (a potentially life-threatening infection of the bloodstream).

3. Pelvic inflammatory disorder (an inflammation of the reproductive organs).

4. Infection of the endometrium, the lining of the uterus, also known as endometritis.

5. Chronic infection (in the case of hepatitis B or C).

How Can Perinatal Infections Be Diagnosed?

Perinatal infections can be diagnosed through a combination of prenatal screening, laboratory testing, and clinical evaluation. Here are some methods that can be used for diagnosis:

• Prenatal Screening: Pregnant women are often screened for certain infections, such as HIV, syphilis, and hepatitis B, during their first prenatal visit. Additional screening may be recommended based on the woman's medical history, risk factors, or geographic location.

• Laboratory Testing: Laboratory tests, such as blood tests or urine tests, can be used to detect the presence of certain infections. For example, a blood test can detect antibodies to HIV or syphilis, while a urine test can detect chlamydia or gonorrhea.

• Imaging: In some cases, imaging tests, such as ultrasound or (magnetic resonance imaging) MRI, may be used to detect fetal abnormalities or other signs of infection.

• Clinical Evaluation: Doctors may also evaluate a newborn for signs of infection, such as fever, rash, or respiratory distress, and may perform additional tests, such as a spinal tap, to confirm a diagnosis.

How Can Perinatal Infections Be Treated?

The treatment of perinatal infections depends on the specific infection and the timing of the diagnosis. In some cases, antiviral or antibiotic medications may be prescribed to the mother during pregnancy or to the newborn after delivery. Here are some examples of treatments for specific infections:

• HIV: Antiretroviral therapy (ART) can help prevent transmission of HIV from mother to child during pregnancy, labor and delivery, and breastfeeding.

• Syphilis: Penicillin is the recommended treatment for syphilis in pregnancy. It is recommended that all pregnant women undergo syphilis screening during their initial prenatal appointment.

• Hepatitis B: To prevent transmission of hepatitis B from mother to infant, it is important to administer the hepatitis B immune globulin (HBIG) and hepatitis B vaccine to newborns within 12 hours of birth if the mother is infected with the virus.

• Group B Streptococcus (GBS): Pregnant women should be screened for GBS between 35 and 37 weeks of pregnancy. Women who test positive for GBS during pregnancy are usually given antibiotics during labor to reduce the risk of transmission to the infant.

What Role Does Prenatal Care Play in Prevention?

Prenatal care plays a critical role in the prevention of perinatal infections. Regular prenatal visits provide an opportunity for healthcare providers to screen for and identify potential infections, provide appropriate treatment, and educate women about how to reduce their risk of transmission. Some examples of prevention strategies include:

• Prenatal Screening: Screening pregnant women for infections during prenatal care can help identify infections early and allow for prompt treatment.

• Vaccination: Some infections, such as rubella and hepatitis B, can be prevented through vaccination before pregnancy or during pregnancy.

• Safe Sex Practices: Using barrier methods, such as condoms, during sex can help reduce the risk of sexually transmitted infections.

• Good Hygiene: Practicing good hygiene, such as washing hands regularly, can help reduce the risk of infections.

What Are the Current Recommendations for Screening and Vaccination to Reduce the Risk of Perinatal Infections?

The current recommendations for screening and vaccination to reduce the risk of perinatal infections include:

1. Rubella Vaccination: Women who are not immune to rubella should receive the rubella vaccine before pregnancy. If a woman is found to be non-immune during pregnancy, then the vaccine should be given after delivery.

2. Influenza Vaccination: Pregnant women should receive the influenza vaccine during flu season to reduce their risk of flu-related complications.

3. Chlamydia and Gonorrhea Screening: All pregnant women should be screened for chlamydia and gonorrhea during the first prenatal visit. Women who test positive should receive prompt treatment to prevent transmission to the infant.

Conclusion

Perinatal infections can have serious consequences for both mothers and infants, including long-term health effects. However, early detection and treatment, along with appropriate prevention strategies such as prenatal screening and vaccination, can help reduce the risk of transmission and minimize the potential harm. Prenatal care plays a critical role in preventing and managing perinatal infections.