HIV/AIDS
5 Common Infections During Pregnancy That Can Be Passed On To The Baby
During pregnancy, a woman goes through several distressing symptoms and is also exposed to various viruses and bacteria, leading to infections. Most infections, for instance, skin, urinary tract, and respiratory tract, do not pose much risk. However, there are times when certain infections can be passed to the foetus before or during birth, which can be dangerous for both the mother and the child. Listed below are some of the common infections that can occur during pregnancy and can be transferred to the baby.
Cytomegalovirus (CMV)CMV is a virus that usually does not cause any serious health complications. However, once you're infected with it, you're likely to have the virus for life.
Dr Ila Jalote, Consultant-Obstetrician and Gynaecologist, Manipal Hospital, Gurugram, says, "CMV is quite common, with up to 60% of adults having been infected by age 40."
Also Read: Urinary Tract Infection In Pregnancy: Know Causes, Symptoms and Prevention Tips
The UK National Health Services (NHS) suggests infections caused by the virus are common in young children, adding, "Infection can be dangerous during pregnancy as it can cause problems for unborn babies, such as hearing loss, visual impairment or blindness, learning difficulties and epilepsy," the health body adds.
While no vaccine is currently available against CMV, Dr Jalote says, "Preventing transmission involves practising good hygiene, like frequent handwashing, especially after contact with young children's saliva or urine. Pregnant women should also avoid sharing utensils or drinks with young children."
Rubella (German Measles)Rubella is an infectious viral disease that is transmitted by the respiratory route and multiplies in the nose, throat and the local lymph nodes. According to the World Health Organization (WHO), it can occur in pregnant women by infecting the placenta and the developing foetus. While rare, the NHS says if a pregnant woman develops rubella in the first 4 months of pregnancy, it can lead to serious problems, including birth defects and miscarriage.
As per Dr Jalote, the MMR (Measles, Mumps, Rubella) vaccine is highly effective in preventing rubella. "Ensuring that women are vaccinated before conception or during prenatal care helps create immunity and prevents transmission," she says.
ToxoplasmosisToxoplasmosis is caused by a parasite called Toxoplasma gondii. It usually occurs when people eat undercooked meat or when they come in contact with cat faeces. In addition, the parasite can pass on from a mother to her baby during pregnancy, as per Mayo Clinic.
Therefore, to prevent the infection, Dr Jalote recommends cooking meat thoroughly, washing fruits and vegetables, wearing gloves when handling soil or cat litter, and having someone else care for the cat's litter box if you are pregnant.
SyphilisSyphilis is a Sexually Transmitted Infection (STI) caused by a bacteria called Treponema pallidum. It is usually transmitted through sexual contact but can also occur via blood transfusion or from a pregnant woman to her foetus, says the WHO, adding, "Maternal syphilis, when untreated, treated late or not treated with penicillin, results in adverse birth outcomes (ABOs) estimated in 50−80% of cases, depending on the stage of syphilis." These include stillbirth (most commonly), neonatal death, prematurity, low birth weight, and congenitally infected infants.
Also Read: How Common Is Kidney Infections In Pregnant Women: Doctor Explains The Condition Pyelonephritis
HIV (Human Immunodeficiency Virus)HIV is a global health issue with more that four crore deaths so far. As per the WHO, there were an estimated 3.9 crore people living with HIV at the end of 2022. In the same year, 6.3 lakh people died from HIV-related causes and 10.3 lakh people got infected with the virus.
The most common way HIV spreads is through the exchange of bodily fluids with people living with the virus. In addition, it can also be passed on to the child during pregnancy and delivery. So what can be done?
Dr Jalote says, "Routine prenatal HIV screening is critical. If a pregnant woman is HIV-positive, antiretroviral medication can significantly reduce the risk of transmission to the baby."
In addition, healthcare providers may also recommend formula feeding instead of breastfeeding to prevent transmission."
Common Ways To Prevent Infections In The First PlaceDr Archana Sinha, Consultant Obstetrician and Gynaecologist, Fortis Hospital, Anandapur, Kolkata shares a few ways to prevent certain infections. These include:
In addition, the doctor recommends consulting a doctor for proper vaccination or medication, stressing on the importance of getting the right vaccine at the right time, which can help both the mother and the baby lead a healthier life.
Mouse Model Of COVID-19 In Pregnancy Shows Benefit Of Paxlovid Treatment
A new mouse model of infection with the COVID-19-causing SARS-CoV-2 virus during pregnancy tracks closely the disease course doctors have observed in SARS-CoV-2-infected pregnant patients, and suggests that treatment with the antiviral Paxlovid provides protection for both mother and child. The new model is described in a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
The researchers found that pregnant mice infected with SARS-CoV-2 later in gestation tended to have worse COVID-19-like disease, as seen in pregnant patients with SARS-CoV-2 infections. Treating the mice with the active ingredients in Paxlovid—an oral antiviral drug approved by the Food and Drug Administration for use against SARS-CoV-2 infection, but not widely used in pregnant patients with COVID-19—reduced their viral loads and disease signs in mothers, and prevented growth and developmental deficits in their offspring.
The study appears online in the Journal of Clinical Investigation.
"Our findings are consistent with the overall public health message that Paxlovid is safe and effective, and that if you're pregnant it can protect you and your baby," says study co-senior author Sabra Klein, Ph.D., professor in the Department of Molecular Microbiology and Immunology at the Bloomberg School.
The COVID-19 pandemic is a reminder that pregnant people are an at-risk population for more severe viral diseases—so much so that they are often among priority groups that receive immediate access to new antiviral treatments when they are authorized or approved by the FDA. During the pandemic, doctors observed that SARS-CoV-2 infection during pregnancy—especially late pregnancy—tends to cause more severe COVID-19, with a threefold greater risk of intensive care admission than the general population, as well as increased risks of preterm birth and neurodevelopmental disorders in affected infants.
Research shows that late pregnancy normally features a suppression of some maternal immune pathways, presumably to help protect the unborn child from maternal immune attack. But just how this leads to worsened viral illness in pregnant mothers and developmental deficits in children has been unclear.
To better understand these mechanisms, Klein and colleagues developed a model of SARS-CoV-2 infection in pregnancy using a standard outbred strain of laboratory mice—which means that like humans, the offspring are not identical to the mother. They exposed three sets of the animals, at three different stages of pregnancy, to a version of SARS-CoV-2 adapted to grow well in mice. The infection stages corresponded roughly to the first, second, and third trimesters of human pregnancy.
The researchers found that the pregnant mice infected in the equivalent of the third trimester had significantly worse disease symptoms, on average, compared to the other pregnant or non-pregnant mice. These symptoms included weight loss, higher levels of virus in the lungs, and evidence of lung damage, and were associated with reduced antiviral immunity.
The offspring of the third trimester-infected mothers also fared worse than the others, with slower brain development and less overall growth. Although the researchers found no sign of direct viral infection in the placentas of the mouse offspring, there was evidence of placental cell loss. The researchers are still investigating how a respiratory virus causes this placental damage, but they suspect that it may work via a disruption of normal levels of the hormone progesterone, which has important roles in establishing the placenta and maintaining pregnancy.
Finally, the researchers tested the ability of Paxlovid to protect pregnant mice from illness following SARS-CoV-2 infection. Paxlovid is a mix of an anti-SARS-CoV-2 drug called nirmatrelvir and an anti-HIV drug called ritonavir—the latter "boosts" the activity of nirmatrelvir by inhibiting an enzyme that would otherwise quickly break it down.
"Mouse-equivalent doses of these two drugs, administered four hours after infection, greatly reduced disease symptoms in mice infected late in pregnancy, and prevented adverse growth and developmental effects on their offspring," says Patrick Creisher, one of the study's co-first authors.
He and Jamie Perry, ScM, were graduate students working in the Klein Lab at the time of the study. Creisher is currently a Ph.D. Student at the Bloomberg School. Perry is a program specialist at the National Institute of Allergy and Infectious Diseases.
Although Paxlovid is FDA-approved for use in pregnancy-based observational studies, pregnant patients were excluded from clinical trials of the treatment, as they have been for most clinical trials since the 1970s, due to concerns about enhanced risk and liability. While most companies study drug toxicity in pregnant animals, they do not typically test drug efficacy in pregnant animals. This exclusion, says Klein, probably helps explain the lower use of the treatment in pregnancy.
"When pregnancy is an exclusion factor in clinical trials, pregnant people inherently question the safety of the drug for them and their babies," she says. "All too often when drugs, including antivirals, are approved for use in pregnant patients, the prescription and uptake is low out of an abundance of caution and fear."
Klein adds that she hopes the results in the new mouse model will encourage greater use of Paxlovid to protect against COVID-19 in pregnancy—and will discourage pharma companies from always treating pregnancy as an exclusion condition, especially in cases like this, where the drugs are safe.
The other co-senior authors of the study were Andrew Pekosz, Ph.D., a professor in the Bloomberg School's Department of Molecular Microbiology and Immunology; and Irina Burd, MD, Ph.D., Sylvan Frieman, MD Professor and chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Maryland School of Medicine.
"Adverse outcomes in SARS-CoV-2 infected pregnant mice are gestational age-dependent and resolve with antiviral treatment" was co-authored by Patrick Creisher, Jamie Perry, Weizhi Zhong, Jun Lei, Kathleen Mulka, Hurley Ryan, Ruifeng Zhou, Elgin Akin, Anguo Liu, Wayne Mitzner, Irina Burd, Andrew Pekosz, and Sabra Klein.
More information: Patrick S. Creisher et al, Adverse outcomes in SARS-CoV-2–infected pregnant mice are gestational age–dependent and resolve with antiviral treatment, Journal of Clinical Investigation (2023). DOI: 10.1172/JCI170687
Citation: Mouse model of COVID-19 in pregnancy shows benefit of paxlovid treatment (2023, October 16) retrieved 27 October 2023 from https://medicalxpress.Com/news/2023-10-mouse-covid-pregnancy-benefit-paxlovid.Html
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Zika Virus Exposure During Pregnancy Slows Fetal Growth And Affects Mother-infant Interaction
Zika virus infection in pregnant rhesus macaques slows fetal growth and affects how infants and mothers interact in the first month of life, according to a new study from researchers at the California National Primate Research Center at the University of California, Davis. The work, published Oct. 25 in Science Translational Medicine, has implications for both humans exposed to Zika virus and for other viruses that can cross the placenta, including SARS-CoV2, responsible for the COVID-19 pandemic.
Initially I thought this was a story about Zika, but as I looked at the results I think this is also a story about how fetal infections in general affect developmental trajectories."
Eliza Bliss-Moreau, professor of psychology at UC Davis and senior author on the paper
In most people, Zika virus infection causes mild or no symptoms and leaves long-lasting immunity. But during pregnancy, the virus can cross the placenta and cause damage to the nervous system of the fetus. In extreme cases, it can cause microcephaly in humans.
While no local transmission of the virus has been reported in the U.S. Since 2018, the mosquitoes that carry Zika virus continue to expand their range throughout Africa, the Americas, Asia and the Pacific.
UC Davis researchers previously showed that Zika virus could enter the fetal brain in pregnant macaques. The new study, led by Bliss-Moreau with Associate Specialist Gilda Moadab, Project Scientist Florent Pittet and colleagues at the CNPRC and UC Davis Department of Psychology, looked at the effects of Zika infection during the second trimester of pregnancy on infants up to a month after birth.
Infection in second trimesterPregnant animals did not become visibly ill with the virus, but ultrasounds showed fetal growth slowed after infection, Pittet said. At birth, Zika-exposed infants were "at the low end" of the range for head size in rhesus macaques.
"They were smaller overall," he said. Higher levels of circulating Zika virus corresponded with longer delays in growth.
After birth, the researchers tracked the development of sensory and motor skills – using tests similar to those used for human babies – and interaction with the mother.
"The trajectory was quite different," Pittet said. Right after birth, infant monkeys spend a lot of time on their mother but start to separate after about two weeks. But the Zika infants spent much more time clinging to their mothers through the first month.
It's not clear whether the mother or the infant is initiating this contact, Bliss-Moreau said.
"We know that moms will keep hold of infants that are having challenges," she said.
Males more affectedSurprisingly, growth delays and effects on mother-infant interactions were greater in male than in female infants, although both showed delays compared to uninfected controls. Infectious disease studies in animals tend to use one sex (usually male) to avoid confounding effects, but potentially missing such sex differences.
Additionally, the animals were housed in established social groups of multiple adult females (including their mother), a single male and other male and female infants of about the same age. This allows the infants to learn from each other and from the adults, Pittet said.
"The presence of unrelated adults and infants in the social group is a critical factor for normative development," he said. "Offering such a social rearing environment is tons of additional work but ensures a lot more relevance to developmental studies."
Upcoming papers will describe the monkeys' growth through the first two years of life. Zika virus exposure during pregnancy sets off a cascade of consequences that may not appear until later in development, Pittet said.
The finding that outcomes correlate with viral load during pregnancy offers opportunities to intervene, the researchers said. A drug or vaccine would not have to completely eliminate the virus to be beneficial. This may be generally true for other infections that can affect the fetus, such as COVID.
"Anything you can do to reduce viral load is a good thing for infant development," Bliss-Moreau said. A 2019 study by CNPRC scientists, in collaboration with the National Institute of Allergy and Infectious Diseases, found that an experimental Zika vaccine lowered levels of circulating viruses in pregnant macaques.
Additional coauthors are: Jeffrey Bennett, Christopher Taylor, Olivia Fiske and Koen van Rompay at the CNPRC; and Anil Singapuri and Lark Coffey, UC Davis School of Veterinary Medicine. The work was supported by grants from the National Institutes of Health.
Source:
Journal reference:
Moadab, G., et al. (2023) Prenatal Zika virus infection has sex-specific effects on infant physical development and mother-infant social interactions. Science Translational Medicine. Doi.Org/10.1126/scitranslmed.Adh0043.
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