Infections In Pregnancy: Expert Answers Frequently Questions
The newborn and the mother are prone to several infections during pregnancy. Expert explains how to prevent these and what should be done in such situations.
During pregnancy the commonest infections which can be passed on to the baby are the 'TORCH' infections
During pregnancy the commonest infections which can be passed on to the baby are the 'TORCH' infections, which are toxoplasma, rubella, cytomegalo virus (CMV) and herpes. Other than these, syphilis and HIV are infections which the woman may have prior to pregnancy and these can be transmitted to her baby during pregnancy and delivery. Infections such as varicella zoser viruses (chicken pox) are of importance only if they happen for the first time during early or late pregnancy.
During delivery the commonest infections which can be transferred to baby and cause harm to it are - group B streptococci (GBS), Neisseria gonorrhoeae (gonorrhoea), hepatitis B, HSV (herpes), HIV, CMV and fungal infections.
The child who is infected during pregnancy or delivery may show early signs of disease with fever and sepsis and this has a high death rate for the newborn. Other intrauterine infections may cause eye defects, hearing loss, mental retardation, abnormalities of arms and legs, skin lesions, heart defects etc.
What precautions should mothers take to prevent infections?
Though not all infections can be avoided, certain precautions may reduce incidence of infections during pregnancy.
The pregnant woman should not go near anyone with infections. She should get immunization such as MMR, hepatitis B, chicken pox vaccine etc. while in childhood.
Avoid intercourse with partner if has lesions on penis (herpes) or has HIV or HbsAG. Should not be in close proximity with cats (transmission of toxoplasmosis ) or eat undercooked pork, lamb, beef (toxoplasmosis infection passes through meat). Testing for infections such as TORCH, HIV, HbsAG, HSV, syphilis and rubella prior to pregnancy. Vaginal and cervical swabs should be taken for diagnosing herpes and streptococcal B cultures infections prior to delivery.
Can the mother take medications during this period?
Some drugs can be taken by the mother during pregnancy if the risk of infection to the mother and child is greater than the damage caused by drugs. Treatment is available for Toxoplasmosis and herpes which occur during pregnancy. Also, HIV positive women should receive treatment during pregnancy.
Streptococcal sepsis in newborn can be reduced by giving the mother antibiotics especially ampicillin.
What are the chances of an HIV positive mother passing the infection to her baby?
An HIV positive woman can transmit the virus to her baby during pregnancy, labour and delivery and through breastfeeding. If she takes no preventive drugs and breastfeeds then the chance of her baby becoming infected is around 20-45%.
Anti-HIV drugs are highly effective at preventing HIV transmission during pregnancy, labour and delivery. If the mother does not breastfeed then a complete course of treatment can cut the risk of transmission to below 2%. A single dose of medicine given to mother and baby during labour can cut the risk to half.
What about chicken pox?
90% of women who become pregnant are already immune to chicken pox (have IgG antibody to varicella zoster) due to childhood exposure. Risk of primary infection with chicken pox is 1 in 1000 pregnancies.
Mothers who get chickenpox during pregnancy are more likely to have complications such as pneumonia, and encephalitis which can even result in death.
If chickenpox occurs in the first 5 months of pregnancy the child can have effects such as skin scarring, eye defects, underdevelopment of arms and legs and mental abnormalities. These severe effects happen in only 1-2% of infected mothers.
Infection in mid pregnancy does not cause many problems.
If the infection to mother happens in the last 1-4 weeks before delivery - upto 50% of babies are infected and 25% of these babies develop clinical chicken pox.
Prevention: In some countries vaccination is done prior to pregnancy planning, if she is not exposed to chickenpox in past but the main prevention is by avoiding contact with a person who has chicken pox.
Women who are exposed to infection can be given immunoglobulin injections.
When is the good time to take chicken pox or hepatitis B vaccine?
Chicken pox vaccine is a relatively new one and not available everywhere. However, if available it is recommended that the first dose be given between 1-12 years and 2 doses at an intervals of 2 months, after 13 years of age.
Hepatitis B- vaccine is given at birth, 1 month and 6 months of age.
If not given in childhood, then a blood hepatitis B test should be done. If negative, immunization should be given in the same way. Sometimes, it may be given even in pregnancy if the woman has had intercourse with a hepatitis B positive partner.
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