Infektion in der Schwangerschaft, Infection during pregnancy

Infections during pregnancy – health risks for the unborn child

Along with the happiness about the pregnancy arises the worry about the unborn’s health. Some pathogens are of particular concern to the expectant mother. They may be transmitted from the mother to the fetus during pregnancy or birth or shortly after birth and can cause aborts, malformations or postnatal infections of the child. They include Toxoplasma gondii (toxoplasmosis), rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV) as well as further pathogens, such as Bordetella pertussis (whooping cough), Chlamydia trachomatis, Parvovirus B19 (fifth disease), Treponema pallidum (syphilis) and Varicella zoster virus (VZV, chickenpox). All together are comprised under the acronym TORCH (for Toxoplasma, Others, Rubella, CMV, HSV).

Determination of the immune status of the mother may help to estimate the risk of primary infections and to avoid corresponding sources of infection. With the EUROLINE Anti-TO.R.C.H. 10 profile serum antibodies (IgG) against 10 pregnancy-relevant infectious agents may be assessed in parallel:

Toxoplasma gondii (Toxoplasmosis)

Toxoplasmosis is an infectious disease which is common in cats. Parasites can be transferred to humans via contact with the faeces of infected cats, or via consumption of raw meat or milk. Those infection sources shall be avoided during pregnancy in case testing reveals that the mother does not have IgG antibodies against the parasite. A positive test result, instead, indicates a previous infection and the antibodies provide a good protection for the mother and her child against future infections.

Rubella virus, Parvovirus B19 (fifth disease) and Varicella zoster virus (chickenpox)

Rubella, fifth disease and chickenpox belong to the classical children’s diseases. Who experienced them once has built-up a life-long basic immunity against the viruses. This can also protect the unborn child when the antibody concentration is sufficiently high. A positive antibody finding should therefore be supported by a quantitative determination of the IgG titer. If testing reveals a lack of immunity prior to a pregnancy, vaccination against rubella and chickenpox can be caught up. If the woman is already pregnant, she should avoid potential sources of infection, e.g. childcare facilities.

Bordetella pertussis (whooping cough)

Whooping cough is also a classical children’s disease. However, the danger for the baby is not the infection during pregnancy but an infection shortly after birth. If the serum sample of the expectant mother showed none or low-concentrated IgG antibodies against Bordetella, vaccination during or after pregnancy would be sensible. Also, the people in the closer surrounding of the baby should be immune/ vaccinated. This way they function as a protective shield for the child and decrease the risk of an infection.

Cytomegalo virus (CMV)

Primary infections with the cytomegalovirus often pass without clinical symptoms and remain unnoticed in most cases, but constitute a major health risk for the unborn child. If the mother has specific IgG antibodies and an acute infection can be excluded, the health risk for the child will be decreased due to the protective effect of the maternal antibodies. However, if the mother lacks immunity against CMV, the risk of infection which may be harmful to the unborn is high after contact with a virus carrier. Transmission usually occurs via smear infection.

Herpes simplex viruses (HSV-1, HSV-2)

More than 80% of the German population carries HSV-1 (main causative agent for herpes blistering in the face), around 20% carry HSV-2 (main causative agent for herpes blistering in the genital region). The characteristic herpes blisters constitute the primary source of infection. Once infected, the virus persists latently within the affected cells. From time to time and not in all virus carriers, the acute disease can break out. With the help of the antibody determination, a persisting infection can be reliably diagnosed. A risk of infection for the child exists during birth if the mother suffers from genital herpes at that time. Also infections after birth (neonatal infections) are dangerous and can lead to severe complications.

Chlamydia trachomatis

Chlamydia trachomatis is one of the most common pathogens of sexually transmitted infectious diseases affecting the urogenital tract. Infections often pass unnoticed in women. However, the bacteria may be transmitted to the child during birth through the infected birth canal. Infections of the respiratory system of the baby can cause severe pneumonia. A positive IgG antibody test result prior to or during pregnancy can either indicate a past infection, which is harmless for the child, or an acute or even chronic infection. The latter have to be treated until birth. Additional tests (e.g. PCR) are required to discriminate between an acute and a past infection. The antibodies do not provide immune protection.

Treponema pallidum (Syphilis)

The infectious agents of syphilis, Treponema pallidum, can be transmitted from the mother to the fetus via the placenta and may lead to aborts and malformations of the baby. Infection during pregnancy hast to be avoided – syphilis is primarily transmitted through unprotected sexual intercourse, however any mucous membrane contact with an infected person may be sufficient. A positive IgG antibody finding is a sign for a past or an acute infection which has to be specified by additional tests (e.g. determination of activity markers, such as lipoid antibodies). An acute syphilis during pregnancy has to be treated as soon as possible. The antibodies do not protect from reinfection.

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