Managing infections in pregnancy.
OBJECTIVE
The management of infection in pregnancy aims mainly at improving the diagnosis and prognosis of congenital infections. Over 400 publications have dealt with this issue over the last 2 years, taking advantage of progress made not only in the epidemiological knowledge of infections but also neonatal treatment and prenatal diagnosis and interventions. The focus remains largely on viral and parasitic infections, namely cytomegalovirus (CMV) and toxoplasmosis, with the appearance of influenza as part of recent and severe outbreaks.


RESULTS
The prevalence of CMV infection is stable. The prediction of foetal infection from primary maternal infection is becoming more accurate and therapeutic approaches are promising, including the development of a vaccine in the near future. The prevalence of toxoplasmosis is decreasing markedly in Europe weakening the effect of preventive measures and questioning the rationale for screening. In addition, the efficacy of prenatal treatment is still under scrutiny, although no appropriate randomized controlled trial (RCT) has been undertaken.


CONCLUSIONS
Accurate dating of maternal primary infection is key to prenatal management including foetal and perinatal surveillance and therapy. Heightened prenatal surveillance following influenza infection in early pregnancy is warranted by an apparent increased risk of nonchromosomal congenital malformations in large epidemiological studies, likely as an effect of maternal hyperthermia.
aObstetrics and Fetal Medicine Department bFETUS Research Unit and Virology Laboratory cNecker-Enfants Malades Hospital, Paris descartes University, Paris, France.
Yves
Y
Ville
Marianne
M
Leruez-Ville
D000328:Adult; D000653:Amniotic Fluid / Q000821:virology; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D011296:Prenatal Diagnosis; D011379:Prognosis; D014125:Toxoplasmosis, Congenital / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D000077562:Valganciclovir
D000981:Antiprotozoal Agents; D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir