PREGNANCY AND SUSCEPTIBILITY TO INFECTIOUS DISEASES

Monday, 6th of October 2014

[source]Infectious Diseases in Obstetrics and Gynaecology[|source]

In the 1950s, the transplant immunologist Peter Medawar proposed that during pregnancy there is a general maternal immune suppression in order to assure tolerance of the semiallogeneic fetus. since the time of Medawar, the understanding of the immune alterations that occur during pregnancy has evolved to include more complex theories of immune alteration. More recently, evidence that adaptive immune responses are weakened, potentially explaining reduced viral clearance has been aduced. At the same time, a boosted innate response which may represent a compensatory immune mechanism to protect the pregnant mother and the fetus, that in turn reduces susceptibility to initial infection has been adduced.

In this report, authors reviewed the available evidence related to infection risk and clinical course/maternal outcomes during pregnancy. The report documents that there is limited evidence that measles displays increased severity during pregnancy. However, the report documents that measles infection before 24 weeks may be associated with spontaneous abortions or stillbirth related to severe maternal disease. More details on the effects of other infectious diseases agents in pregnancy,  are accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723080/#!po=62.5000

 

ABSTRACT

To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.