Pregnant women at risk for host of ills 

Pregnant women at risk for host of ills

Pregnant women can get a variety of infections with consequences that range from minor to dire ' for mom, baby or both.

Those charged with providing prenatal care and delivering babies must know when to wait for symptoms, when to screen and what the treatment options are, according to a certified nurse-midwife who spoke to her peers Wednesday at a national conference in Salt Lake City.

Jan M. Kriebs of the University of Maryland provided an update on infections during pregnancy as part of the American College of Nurse-Midwives conference at Grand America Hotel. The five-day education session ends today.

Pregnant women can take steps to avoid some infections, starting with good hygiene. Hand washing prevents transmitting many types of bacteria. For example, staph aureus colonizes on the skin or in the nose of 25 to 30 percent of the population, and 1 percent of the population carries an antibiotic-resistant strain called MRSA. Hand washing is a power tool against spreading it.

Some foods, like unpasteurized milk, raw smoked seafood and soft cheeses can cause a severe food-poisoning called listeriosis. One-third of the cases involve pregnant women, who may have only mild flu-like symptoms, while their babies may be born early, be stillborn or develop severe illness.

Pregnant women shouldn't change kitty litter, because although the risk of infection is very slight ' less than 1 percent ' it can lead to toxoplasmosis, which may also be caused by undercooked meats or contaminated soil. Infants who get the infection from their mothers may appear healthy at birth and develop symptoms later, some of them very severe.

Most pregnancies proceed just fine. But infection is a potential problem that must be considered. And how rare or common a bacterium is has little to do with the damage it can cause or whether screening is needed.

It's believed one in four adult women have Herpes Simplex virus 2 (most often affecting genitals) or 1 (more commonly affecting faces), usually transmitted from someone who has no symptoms. An estimated 45 million Americans have the disease, Kriebs says, and 70 percent don't know they have it. Early in the pregnancy, risk of infecting a baby is small. Infection may not be discovered until seven to 11 days after delivery. Symptoms or complications run the gamut from mild, localized sores to long-term disability or death.

Kriebs predicts the high incidence among women will soon prompt routine screening for the infection as part of prenatal care.

Syphilis cases in women have plummeted in the United States since they peaked in the late '80s and early '90s. Still, if it is untreated in pregnant women, there's a good likelihood it will be passed on to the fetus. Many of those fetuses are stillborn.

A study of 451 babies nationwide who were born in 2002 infected with syphilis found that two-thirds of the mothers received some prenatal care. But three-fourths of the time, treatment was inadequate or missing altogether.

"We ought to be able to do something about this with prenatal care," Kriebs says, "But if two-thirds had care and three-fourths were not adequately treated, where were we?"

Risk and outcomes can be vastly different for mom and baby, depending on the type of infection.

Cytomegalovirus is very common in adults, most with no symptoms. Screening for it, absent symptoms, is not recommended. It is seldom transmitted in pregnancy, and there's no way to prevent infecting a baby. Treatment focuses on symptoms, but unfortunately, many of the babies who develop symptoms die.

While mumps poses little threat to mothers long-term, it may increase the risk of miscarriage. Rubella carries a low rate of complication for mothers, but babies may be miscarried, be born early or develop a syndrome that may include deafness, cataracts, heart problems and other complications such as liver damage or mental retardation.

Chicken pox raises the stakes for mothers. Kriebs says 10 percent of pregnant women who are infected develop severe pneumonia. Babies, depending on when in their development they're exposed, may have limb atrophy, scarring and other problems. Exposure close to time of birth may be fatal to a baby. Influenza danger increases as women get further into their pregnancies. And unlike many of the infections, where a vaccine is not recommended after the woman is pregnant, women who will be in their second or third trimester during flu season are encouraged to get a vaccine.

Herpes Treatment