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Infections in pregnancy

Caitlin L Keighley, Hannah JM Skrzypek, Angela Wilson, Michael A Bonning and Gwendolyn L Gilbert
Med J Aust 2019; 211 (3): . || doi: 10.5694/mja2.50261
Published online: 5 August 2019

Summary

  • Infections in pregnancy represent a challenging and often underappreciated area of concern for many specialists and general practitioners and can cause serious sequelae.
  • Antenatal status should be highlighted on pathology request forms, as this serves to alert the laboratory of the need to store serum for an extended period. Prior antenatal specimens can be forwarded to other laboratories to enable testing in parallel with the more recent sample.
  • Women with a confirmed, potentially vertically transmissible infection should be referred to a specialist with expertise in the management of perinatal infections.
  • Cytomegalovirus infection is the most common congenital infection. Women who care for young children are at greater risk of exposure to the virus. Preventive steps including hand hygiene and avoiding contact with children's urine, mucous and saliva are recommended for all pregnant women.
  • The incidence of parvovirus B19 infection in pregnancy is unknown. This infection is highly contagious and may result in fetal loss; particularly in the first half of pregnancy, pregnant women should avoid contact with adults or children who may have an infection.

  • 1 Institute for Clinical Pathology and Medical Research, NSW Health Pathology Centre for Infectious Diseases and Microbiology, Sydney, NSW
  • 2 University of Sydney, Sydney, NSW
  • 3 Mercy Hospital for Women, Melbourne, VIC
  • 4 Alice Springs Hospital, Alice Springs, NT
  • 5 GP Synergy, Sydney, NSW
  • 6 Macquarie University, Sydney, NSW
  • 7 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW
  • 8 Sydney Health Ethics, University of Sydney, Sydney, NSW



Competing interests:

No relevant disclosures.

  • 1. Gilbert GL. Infections in pregnant women. Med J Aust 2002; 176: 229–236. https://www.mja.com.au/journal/2002/176/5/1-infections-pregnant-women
  • 2. Palasanthiran P, Starr M, Jones C, Giles M; editors. Management of perinatal infections. Sydney: Australasian Society for Infectious Diseases, 2014. https://www.asid.net.au/documents/item/368 (viewed Nov 2018).
  • 3. Public Health Laboratory Network. Laboratory case definitions for diagnosis of communicable diseases. Canberra: Commonwealth of Australia, 2017. http://www.health.gov.au/internet/main/publishing.nsf/Content/Laboratory%2Bcase%2Bdefinitions-1 (viewed Nov 2018).
  • 4. Communicable Diseases Network Australia. CDNA national guidelines for public health units: syphilis. Canberra: Department of Health, 2015. http://www.health.gov.au/internet/main/publishing.nsf/content/B2ECD660086F7FCBCA257C94001BFB4B/$File/syphilis-SoNG2018.pdf (viewed Aug 2018).
  • 5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of hepatitis C in pregnancy. RANZCOG, 2016. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Maternal-Group-BStreptococcus-in-pregnancy-screening-andmanagement-(C-Obs-19)-Review-March-2016.pdf?ext=.pdf (viewed Sep 2018).
  • 6. Visvanathan K, Dusheiko G, Giles M, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow‐up: position paper produced by Australian, UK and New Zealand key opinion leaders. Gut 2016; 65: 340–350.
  • 7. Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Transmission in the United States. AIDSinfo, 2018. http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf (viewed May 2018).
  • 8. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Maternal group B streptococcus in pregnancy: screening and management. RANZCOG, 2016. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Maternal-Group-B-Streptococcus-in-pregnancy-screening-and-management-(C-Obs-19)-Review-March-2016.pdf?ext=.pdf (viewed June 2018).
  • 9. Loto OM, Awowole I. Tuberculosis in pregnancy: a review. J Pregnancy 2012; 2012: 379271.
  • 10. Gilbert GL, Hewitt MC, Turner CM, Leeder SR. Epidemiology and predictive values of risk factors for neonatal group B streptococcal sepsis. Aust N Z J Obstet Gynaecol 2002; 42: 497–503.
  • 11. Centers for Disease Control and Prevention. 10 tips for preventing infections before and during pregnancy. Atlanta: CDC, 2018. https://www.cdc.gov/pregnancy/infections.html (viewed July 2018).
  • 12. NSW Food Authority. Foods to eat or avoid when pregnant. Sydney: NSW Food Authority, 2016. http://www.foodauthority.nsw.gov.au/foodsafetyandyou/life-events-and-food/pregnancy/foods-to-eat-or-avoid-when-pregnant (viewed Nov 2018).
  • 13. Royal Women's Hospital. Health information: A–Z facts. [website]. https://www.thewomens.org.au/health-information/fact-sheets (viewed May 2019).
  • 14. Mercy Hospital for Women. Planning your pregnancy [website]. https://mercyperinatal.com/for-patients-and-families/planning-your-pregnancy (viewed May 2019).
  • 15. Department of Health. Pregnancy care guidelines. Canberra: Commonwealth of Australia, 2018. https://beta.health.gov.au/resources/pregnancy-care-guidelines (viewed Nov 2018).
  • 16. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Routine antenatal assessment in the absence of pregnancy complications. RANZCOG, 2016. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Routine-Antenatal-Assessment-(C-Obs-3(b))-Review-July-2016.pdf?ext=.pdf (viewed Nov 2018).
  • 17. Department of Health. Clinical practice guidelines: pregnancy care. Canberra: Commonwealth of Australia, 2018. https://beta.health.gov.au/resources/publications/pregnancy-care-guidelines (viewed Nov 2018).
  • 18. Australian Technical Advisory Group on Immunisation. Australian immunisation handbook. Canberra: Commonwealth of Australia, 2018. https://Immunisationhandbook.health.gov.au (viewed Oct 2018).
  • 19. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Influenza vaccination during pregnancy (and in women planning pregnancy). RANZCOG, 2017. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Influenza-vaccination-in-pregnancy-(C-Obs-45)-Review-March-2017.pdf?ext=.pdf (viewed May 2018).
  • 20. National Health and Medical Research Council. Clinical practice guidelines: pregnancy care. Canberra: NHMRC; 2018. https://www.clinicalguidelines.gov.au/portal/2589/clinical-practice-guidelines-pregnancy-care-2018-edition (viewed Oct 2018).
  • 21. Gilbert GL. Infectious diseases in pregnancy and newborn infant. Switzerland: Harwood Academic Publications, 1991.
  • 22. Naing ZW, Scott GM, Shand A, et al. Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention. Aust N Z J Obstet Gynaecol 2016; 56: 9–18.
  • 23. Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017; 17: e177–e188.
  • 24. Bright A, Dups J. Infectious and congenital syphilis notifications associated with an ongoing outbreak in northern Australia. Commun Dis Intell Q Rep 2016; 40: E7–E10.
  • 25. Ward JS, Guy RJ, Arke SP, et al. Epidemiology of syphilis in Australia: moving toward elimination of infectious syphilis from remote Aboriginal and Torres Strait Islander communities? Med J Aust 2011; 194: 525–529. https://www.mja.com.au/journal/2011/194/10/epidemiology-syphilis-australia-moving-toward-elimination-infectious-syphilis.
  • 26. Berrebi A, Assouline C, Bessieres MH, et al. Long‐term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010. 203: 552.e1–e6.
  • 27. Bessieres MH, Berrebi A, Rolland M, et al. Neonatal screening for congenital toxoplasmosis in a cohort of 165 women infected during pregnancy and influence of in utero treatment on the results of neonatal tests. Eur J Obstet Gynecol Reprod Biol 2001; 94: 37–45.
  • 28. Chaudhry SA, Gad N, Koren G. Toxoplasmosis and pregnancy. Can Fam Physician 2014; 60: 334–336.
  • 29. Jayamaha JC, Robertson P, Rawlinson WD. Congenital toxoplasmosis over 10 years in a low‐incidence population. Med J Aust 2012; 196: 443–444. https://www.mja.com.au/journal/2012/196/7/congenital-toxoplasmosis-over-10-years-low-incidence-population
  • 30. Thiebaut R, Leproust S, Chene G, Gilber T; Syrocot Study Group. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta‐analysis of individual patients’ data. Lancet 2007; 369: 115–122.
  • 31. Deverell M, Phu A, Zurynski Y, Elliott E. Australian Paediatric Surveillance Unit annual report, 2016. Commun Dis Intell Q Rep 2017; 41: E288–E293. http://www.health.gov.au/internet/main/publishing.nsf/Content/72090ED4D53F6ED8CA2581FD00198DE8/$File/CDI4103-n.pdf (viewed Nov 2018).
  • 32. Westhoff GL, Little SE, Caughey AB. Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections. Obstet Gynecol Surv 2011; 66: 629–638.
  • 33. Straface G, Selmin A, Zanardo V, et al. Herpes simplex virus infection in pregnancy. Infect Dis Obstet Gynecol 2012; 2012: 385697.
  • 34. Sintchenko V, Field PR, Gilbert GL. Rubella antibody in antenatal clinic patients. Aust N Z J Med 1999; 29: 284–285.
  • 35. Trotta M, Borchi B, Niccolai A, et al. Epidemiology, management and outcome of varicella in pregnancy: a 20‐year experience at the Tuscany Reference Centre for Infectious Diseases in Pregnancy. Infection 2018; 46: 693–699.
  • 36. Tan HF, Chang CK, Tseng HF, Lin W. Evaluation of the National Notifiable Disease Surveillance System in Taiwan: an example of varicella reporting. Vaccine 2007; 25: 2630–2633.
  • 37. Pinninti SG, Kimberlin DW. Management of neonatal herpes simplex virus infection and exposure. Arch Dis Child Fetal Neonatal Ed 2014; 99: F240–F244.
  • 38. Kelly HA, Siebert D, Hammond R, et al. The age‐specific prevalence of human parvovirus immunity in Victoria, Australia compared with other parts of the world. Epidemiol Infect 2000; 124: 449–457.
  • 39. Wong SF, Chan FY, Cincotta RB, Tilse M. Human parvovirus B19 infection in pregnancy: should screening be offered to the low risk population? Aust N Z J Obstet Gynaecol 2002; 42: 347–351.
  • 40. Lamont RF, Sobel JD, Valsbuch E, et al. Parvovirus B19 infection in human pregnancy. BJOG 2011; 118: 175–186.
  • 41. Pomar L, Malinger G, Benoist G, et al. Association between Zika virus and fetopathy: a prospective cohort study in French Guiana. Ultrasound Obstet Gynaecol 2017; 49: 729–736.
  • 42. Leruez‐Ville M, Ville Y. Fetal cytomegalovirus infection. Best Pract Res Clin Obstet Gynaecol 2017; 38: 97–107.
  • 43. Hui L, Wood G. Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester: a practical update and counseling aid. Prenat Diagn 2015; 35: 1–7.
  • 44. Hughes BL, Gyamfi‐Bannerman C; Society for Maternal–Fetal Medicine. Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016; 214: B5–B11.
  • 45. Kagan KO, Hamprecht K. Cytomegalovirus infection in pregnancy. Arch Gynecol Obstet 2017; 296: 15–26.
  • 46. Bartlett AW, McMullan B, Rawlinson WD, Palansanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: a systematic review. Rev Med Virol 2017. https://doi.org/10.1002/rmv.1938. [Epub ahead of print]
  • 47. Goderis J, De Leenheer E, Smets K, et al. Hearing loss and congenital CMV infection: a systematic review. Pediatrics 2014; 134: 972–982.
  • 48. Robert‐Gangneux F. It is not only the cat that did it: how to prevent and treat congenital toxoplasmosis. J Infect 2014; 68 (Suppl): S125–S133.
  • 49. Karunajeewa H, Siebert D, Hammond R, et al. Seroprevalence of varicella zoster virus, parvovirus B19 and Toxoplasma gondii in a Melbourne obstetric population: implications for management. Aust N Z J Obstet Gynaecol 2001; 41: 23–28.
  • 50. Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009; 39: 1385–1394.
  • 51. Paquet C, Trois‐Rivieres QC, Yudin MH; Society of Obstetricians and Gynaecologists of Canada. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can 2013; 35: 78–81.
  • 52. Pomares C, Montoya JG. Laboratory diagnosis of congenital toxoplasmosis. J Clin Microbiol 2016; 54: 2448–2454.
  • 53. Faucher B, Garcia‐Meric P, Franck J, et al. Long‐term ocular outcome in congenital toxoplasmosis: a prospective cohort of treated children. J Infec 2012; 64: 104–109.
  • 54. Salviz M, Montoya JG, Nadol JB, Satnos F. Otopathology in congenital toxoplasmosis. Otol Neurotol 2013; 34: 1165–1169.
  • 55. de Oliveira Azevedo CT, do Brasil PE, Guida L, Lopes Moreira ME. Performance of polymerase chain reaction analysis of the amniotic fluid of pregnant women for diagnosis of congenital toxoplasmosis: a systematic review and meta‐analysis. PLoS ONE 2016; 11: 0149938.
  • 56. Gras L, Wallon M, Pollak A, Cortina‐Borja M, et al. Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres. Acta Paediatr 2005; 94: 1721–1731.
  • 57. National Notifiable Diseases Surveillance System. Number of notifications of rubella congenital, received from state and territory health authorities in the period of 1991 to 2017 and year‐to‐date notifications for 2018. Canberra: Commonwealth of Australia, 2018. http://www9.health.gov.au/cda/source/rpt_4.cfm (viewed Apr 2018).
  • 58. LeBaron CW, Forghani B, Beck C, et al. Persistence of mumps antibodies after 2 doses of measles‐mumps‐rubella vaccine. J Infect Dis 2009; 199: 552–560.
  • 59. Best JM. Rubella. Semin Fetal Neonatal Med 2007; 12: 182–192.
  • 60. Cradock‐Watson JE, Ridehalgh MK, Anderson MJ, Pattison JR. Outcome of asymptomatic infection with rubella virus during pregnancy. J Hyg (Lond) 1981; 87: 147–154.
  • 61. Ahn KH, Park YJ, Hong SC, et al. Congenital varicella syndrome: a systematic review. J Obstet Gynaecol 2016; 36: 563–566.
  • 62. Gilbert GL. Parvovirus B19 infection and its significance in pregnancy. Commun Dis Intell 2000; 24 (Suppl): 69–71.
  • 63. Bascietto F, Liberati M, Murgano D, et al. Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta‐analysis. Ultrasound Obstet Gynecol 2018; 52: 569–576.
  • 64. Enders M, Klingel K, Weidner A, et al. Risk of fetal hydrops and non‐hydropic late intrauterine fetal death after gestational parvovirus B19 infection. J Clin Virol 2010; 49: 163–168.
  • 65. Verduin EP, Lindenburg IT, Smits‐Wintiens VE, et al. Long‐term follow up after intra‐uterine transfusions; the LOTUS study. BMC Pregnancy Childbirth 2010; 10: 77–84.
  • 66. Giorgio E, De Oronzo MA, Iozza I, et al. Parvovirus B19 during pregnancy: a review. J Prenat Med 2010; 4: 63–66.
  • 67. Rodis JF, Borgida AF, Wilson M, et al. Management of parvovirus infection in pregnancy and outcomes of hydrops: a survey of members of the Society of Perinatal Obstetricians. Am J Obstet Gynecol 1998; 179: 985–988.
  • 68. World Health Organization. Information for travellers vising Zika affected countries. WHO, 2017. https://www.who.int/csr/disease/zika/information-for-travelers/en (viewed Oct 2018).
  • 69. Centers for Disease Control and Prevention. Zika travel information. CDC, 2019. https://wwwnc.cdc.gov/travel/page/zika-travel-information (viewed May 2019).
  • 70. Paz‐Bailey G, Rosenberg ES, Doyle K, et al. Persistence of Zika virus in body fluids — preliminary report. N Engl J Med 2017; 379: 1234–1243.
  • 71. Mead PS, Duggal NK, Hook SA, et al. Zika virus shedding in semen of symptomatic infected men. N Engl J Med 2018; 378: 1377–1385.
  • 72. Brasil P, Pereira JP, Moreira ME, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016; 375: 2321–2334.
  • 73. Alvarado‐Socarras JL, Idrovo AJ, Contreras‐Garcia GA. Congenital microcephaly: a diagnostic challenge during Zika epidemics. Travel Med Infect Dis 2018; 23: 14–20.
  • 74. Coelho AV, Crovella S. Microcephaly prevalence in infants born to Zika virus‐infected women: a systematic review and meta‐analysis. Int J Mol Sci 2017; 18: 1714–1724.
  • 75. Reynolds MR, Jones AM, Petersen EE, et al. Vital signs: update on Zika virus‐associated birth defects and evaluation of all US infants with congenital Zika virus exposure — US Zika Pregnancy Registry, 2016. MMWR Morb Mortal Wkly Rep 2017; 66: 366–373.
  • 76. Singh RK, Dhama K, Karthik K, et al. Advances in diagnosis, surveillance, and monitoring of Zika virus: an update. Front Microbiol 2017; 8: 2677.
  • 77. Basile K, Kok J, Dwyer DE. Zika virus: what, where from and where to? Pathology 2017; 49: 698–706.
  • 78. Hawkes RA, Pamplin J, Boughton CR, Naim HM. Arbovirus infections of humans in high‐risk areas of south‐eastern Australia: a continuing study. Med J Aust 1993; 159: 159–162.
  • 79. Department of Health. Zika virus — information for clinicians and public health practitioners: advice to travellers. Canberra: Commonwealth of Australia, 2018. http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-zika-health-practitioners.htm#travellers (viewed July 2018).
  • 80. Morshed MG, Singh AE. Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol 2015; 22: 137–147.
  • 81. Hong FC, Wu XB, Yang F, et al. Risk of congenital syphilis (CS) following treatment of maternal syphilis: results of a CS control program in China. Clin Infect Dis 2017; 65: 588–594.
  • 82. Multijurisdicional Syphilis Outbreak Working Group (MJSO) of the Communicable Diseases Network of Australia. Infectious syphilis outbreak. Canberra: Commonwealth of Australia, 2018. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-infectious-syphilis-outbreak.htm (viewed May 2018).
  • 83. Jamil MS, Gunaratnam P, McManus H, et al. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2017. Sydney: Kirby, 2017 https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_Annual-Surveillance-Report-2017_compressed.pdf (viewed May 2018).
  • 84. Goulet V, Hebert M, Hedbert C, et al. Incidence of listeriosis and related mortality among groups at risk of acquiring listeriosis. Clin Infect Dis 2012; 54: 652–660.
  • 85. Madjunkov M, Chaudhry S, Ito S. Listeriosis during pregnancy. Arch Gynecol Obstet 2017; 296: 143–152.
  • 86. Pouillot R, Hoelzer K, Jackson KA, et al. Relative risk of listeriosis in Foodborne Diseases Active Surveillance Network (FoodNet) sites according to age, pregnancy, and ethnicity. Clin Infect Dis 2012; 54 (Suppl): S405–S410.
  • 87. Charlier C, Perrodeau E, Leclercq A. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis 2017; 17: 510–519.
  • 88. NSW Department of Primary Industries. Listeria outbreak investigation: summary report for the melon industry; October 2018. Sydney: NSW DPI, 2018. http://www.foodauthority.nsw.gov.au/_Documents/foodsafetyandyou/listeria_outbreak_investigation.pdf (viewed Nov 2018).

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