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Maternal to Fetal Infections

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Antibodies in the maternal blood prevent most infections from being transmitted to the fetus. However some maternal-to-fetal infections, particularly in the first trimester of pregnancy, can cause miscarriage or severe birth defects. Other infections can cause preterm labor, fetal or neonatal death, or serious illness in newborns. Perinatal transmissions infect the fetus after its protective membranes rupture—the waters break—and during labor and delivery when the fetus is exposed to maternal blood. Perinatal transmission is more likely if the waters break prematurely. Toxoplasmosis Up to one-third of all people are infected with toxoplasmosis. The U.S. Centers for Disease Control and Prevention (CDC) estimate that 25-45% of women of childbearing age carry the parasite Toxoplasma gondii that causes toxoplasmosis. Very few infected people have symptoms and most pregnant women have antibodies that protect the fetus from infection. However in one-third of women who are infected for the first time during pregnancy, the parasite infects the placenta and enters the fetal circulation. Congenital (present at birth) infection occurs in one out of every 800-1,400 infants born to infected mothers. The fetal infection rate is above 60% if maternal infection occurs during the third trimester, but the most severe fetal complications occur with first-trimester infection. Viral respiratory infections Cytomegalovirus (CMV) is the most common infection that can be transmitted to a fetus. From 50-80% of childbearing-age women have been infected by CMV prior to pregnancy. However about 1-3% of women have their first or primary CMV infection during pregnancy and about one-third of these infections are transmitted to fetuses. Although most infants with congenital CMV have no problems, infection in early pregnancy can cause miscarriage or birth defects and CMV is a leading cause of congenital deafness. In later pregnancy CMV infection may cause preterm labor, stillbirth, or serious newborn illness. In the United States about 8,000 infants annually are born with potentially fatal CMV-related birth defects. Fifth disease, caused by the parvovirus B19, is very common among children. About one-half of all adults are susceptible. About one-third of infants whose mothers contract fifth disease during pregnancy show signs of infection at birth. Although not usually dangerous, fifth disease contracted early in pregnancy can cause miscarriage or severe fetal anemia (low blood count) that can lead to congestive heart failure. A fetus infected from its mother by Varicella zoster virus may develop pocks that can cause limb deformities early in development. If a woman contracts varicella (chickenpox) during the first 20 weeks of pregnancy, there is a 2% chance that her newborn will have varicella syndrome. However the greatest risk from varicella is if the mother contracts the virus just before delivery when she has not yet produced antibodies to protect the newborn. In the past rubella was a common cause of birth defects. However routine vaccinations have made prenatal infection rare in the developed world. Rubella infection during the first 10 weeks of pregnancy may cause fetal death and more than 50% of newborns have severe birth defects. Infections contracted later in pregnancy do not cause congenital defects, although the newborn may become seriously ill and eventually develop diabetes mellitus. Bacterial infections Invasive group B streptococcal (GBS) disease is the most common cause of life-threatening infection in newborns. Up to 20% of pregnant women carry GBS in their vaginas during the last trimester, with the potential of infecting the fetus during birth. Although premature infants are more susceptible to GBS, 75% of infected infants are full-term. During the 1970s GBS emerged as the most common cause of newborn sepsis, or blood infection, and meningitis—infection of the fluid and lining surrounding the brain. GBS also is a frequent cause of newborn pneumonia. Maternal infection at conception or within the first two weeks of pregnancy may lead to hearing and vision loss and mental retardation. Between 1993 and 2002 congenital GBS infection in the United States decreased from 1.7 per 1,000 live births to 0.4 per 1,000 due to the use of antibiotics during delivery. The food-borne bacterial infections listeriosis—caused by Listeria monocytogenes—and salmonellosis or food poisoning—caused by Salmonella bacteria—can be transmitted to a fetus. Listeria monocytogenes is ubiquitous in soil and groundwater, on plants, and in animals. Most human infections result from ingesting contaminated foods. Hormonal changes make pregnant women about 20 times more likely than other healthy adults to contract listeriosis and about one-third of all cases occur in pregnant women. Listeriosis can cause miscarriage, fetal or newborn death, premature delivery, or severe illness in the mother and infant. Each year an estimated 8,000 pregnant women in the United States are infected with syphilis caused by the spirochete Treponema pallidum. Rising rates of syphilis among pregnant women are increasing the number of infants born with congenital syphilis. Congenital syphilis is a severe, disabling, and often life-threatening disease that can cause facial deformity, blindness, and deafness. Every year in the United States an estimated 40,000 pregnant women are infected with gonorrhea—caused by Neisseria gonorrhoeae—and an estimated 200,000 are infected with chlamydia—caused by Chlamydia trachomatis. Chlamydia can cause premature membrane rupture and labor. Both infections can cause newborn conjunctivitis—a discharge of pus from the eyes. Sexually transmitted viral infections Each year an estimated 8,000 pregnant American women are infected with HIV, the human immunodeficiency virus that causes acquired immune deficiency syndrome (AIDS). About 20-25% of pregnant women with untreated HIV transmit it to their fetuses. In developed countries widespread HIV testing and anti-retroviral therapy have reduced maternal-fetal transmission dramatically. Genital herpes are caused by herpes simplex virus (HSV) type-2 and, less frequently, by HSV type-1 that usually causes cold sores. About 25% of American adults are infected with HSV-2, affecting one in 1,800-5,000 live births. There is little risk of fetal transmission if the mother is infected before the third trimester and has no genital sores at the time of delivery. However infection during the third trimester—when the virus is likely to be active and the mother has not yet made sufficient antibodies to protect her fetus—may lead to congenital HSV infection. This can seriously damage the newborn's eyes, central nervous system, and internal organs, lead to mental retardation and, rarely, death. Genital or venereal warts are caused by some types of human papillomavirus (HPV). At least 20 million Americans are infected and about 5.5 million new cases are reported annually. Genital warts are highly infectious and tend to grow faster during pregnancy. If vaginal warts are very large they may interfere with the infant's passage through the birth canal, necessitating a cesarean section (C-section). An estimated 8,000 pregnant women are infected with hepatitis B in the United States every year. They are at risk for premature delivery and, if untreated, newborns may develop chronic liver disease.

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