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RESEARCH AND PRACTICE |
Sonja A Rasmussen is with the Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Edward B. Hayes is with the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention.
Correspondence: Requests for reprints should be sent to Sonja A. Rasmussen, 1600 Clifton Road NE, Centers for Disease Control and Prevention, MS E-86, Atlanta, GA 30333 (e-mail: skr9{at}cdc.gov).
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ABSTRACT |
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 TOP ABSTRACT References |
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As public health professionals respond to emerging infections, particular attention needs to be paid to pregnant women and their offspring. Pregnant women might be more susceptible to, or more severely affected by, emerging infections. The effects of a new maternal infection on the embryo or fetus are difficult to predict. Some medications recommended for prophylaxis or treatment could harm the embryo or fetus. We discuss the challenges of responding to emerging infections among pregnant women, and we propose strategies for overcoming these challenges.
Recent outbreaks of West Nile virus disease,1 severe acute respiratory syndrome,2 monkeypox,3 and anthrax,4 and concern over pandemic influenza5 and bioterrorism,6 highlight the importance of responding to emerging infections7 (defined as those for which the incidence has risen in the past 2 decades or threatens to rise in the near future).8 In developing response strategies, public health practitioners must consider the impact of strategies on pregnant women and their offspring,7,9–14 so that exposed women are appropriately advised and treated. We outlined challenges that public health professionals face regarding emerging infections in pregnant women and propose strategies for response (Table 1
).
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Because seemingly benign maternal infections can have serious consequences on the health of the embryo or fetus (hereafter referred to as "fetus"),24,25 potential manifestations of infection in pregnant women should be carefully evaluated. Public health professionals should educate health care providers about emerging infections occurring in their area, available diagnostic testing, preventive measures, and treatment. Providers should be encouraged to have a high index of suspicion for emerging infections when evaluating symptoms in pregnant women. For some infections (e.g., HIV),26,27 screening of asymptomatic women might be indicated to prevent or provide early treatment of congenital infection.
Certain vaccinations or medications are contraindicated during pregnancy because of their potential fetal effects.28 Fetal effects of most medications are not known.29 Benefits of the vaccine or medication to be used for prophylaxis or treatment need to be weighed against the potential risk to the fetus. For example, information on ciprofloxacin, the recommended antimicrobial for adult postexposure prophylaxis against Bacillus anthracis, during pregnancy is limited.30 However, given the high morbidity and mortality known to be associated with anthrax, the benefits of ciprofloxacin prophylaxis have been deemed to outweigh the potential risks in women with high-risk exposure.31
The effects of some infections are well known;25 however, for an emerging infection, diverse fetal effects of infection need to be considered. The risk for transmission from mother to fetus and the likelihood of adverse fetal effects can vary with the gestational timing of infection.32,33 Fetal effects can vary depending on the infectious agent and include spontaneous abortions, preterm birth, intrauterine growth retardation, neonatal sepsis, birth defects, and developmental disabilities. Some congenital infections can cause later manifestations (e.g., hearing loss) in infants appearing normal at birth.33 Careful physical and developmental examination of infants born to infected women is essential, but it can be difficult to determine additional studies to be performed. Cardiac echocardiography, ophthalmologic examination, brain imaging, and hearing evaluation all could be considered, and surveillance for effects of congenital infections needs to continue beyond the newborn period.
Diagnosis of a new congenital infection can be difficult. New diagnostic assays developed for adults may need to be applied without data regarding their sensitivity and specificity for congenital infection. Microbial culture, nucleic acid amplification, and immunohistochemical staining can document infection, but sensitivity of these tests is limited. Detection of specific IgM in infant serum provides strong evidence of congenital infection.34 However, false-positive IgM results have been reported,35,36 and infection early in pregnancy might not elicit a fetal IgM response.35,37 Because maternal IgG in the infant’s circulation disappears by age 12 months, documenting increasing or persistent microbial-specific IgG several months after birth may indicate congenital infection.34,35 Because health care providers might not be familiar with difficulties associated with diagnosis of congenital infection, public health professionals should provide training about appropriate diagnostic specimens and timing of specimen collection to diagnose an emerging infection.
As public health professionals deal with emerging infections, they must consider the impact of infectious agents on pregnant women and their offspring. A carefully planned public health approach, which includes input from individuals with expertise in pediatrics, obstetrics, and infectious diseases, will improve our ability to protect women and their offspring from adverse consequences associated with emerging infections.
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Acknowledgments |
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Human Participant Protection
No protocol approval was needed for this review.
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Footnotes |
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Contributors
S. A. Rasmussen and E. B. Hayes formulated the concepts, reviewed the pertinent literature, and wrote the paper.
Accepted for publication January 3, 2005.
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References |
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TOPABSTRACTReferences |
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
