Infectious Diseases in Pregnancy

Infectious diseases are important causes of both morbidity and mortality worldwide. Women and infants bear a significant proportion of disease morbidity because of complications associated with pregnancy. Sexually transmitted infections like gonorrhea and chlamydia can cause infertility or ectopic pregnancy. Many infections have been associated with preterm birth. Infections with viruses such as cytomegalovirus and varicella can cause structural fetal abnormalities. These and other perinatally acquired infections can lead to neonatal blindness or stillbirth. When considered as a group, infections are one of the most common complications of pregnancy. The economic and social burdens of these diseases among women are staggering and worthy of significant attention.

This issue of the Clinics in Perinatology presents the unique aspects of selected infectious diseases that cause important complications of pregnancy. Dr. Goldenberg and colleagues open the issue with an excellent discussion of the impact of infectious diseases on specific pregnancy outcomes. Preterm birth remains one of the most important problems in obstetrics and gynecology today. Evidence continues to emerge implicating infection as a major etiologic factor, particularly in the earliest of these births. Dr. Boggess presents the latest research in this exciting field. The current evidence supporting interventions for preterm labor and preterm premature rupture of the membranes is reviewed by Dr. Newton, who provides important practical clinical information. This section is rounded out by Drs. Schrag and Schuchat who present an excellent review of interventions to prevent neonatal sepsis. They address strategies for the prevention of group B streptococcal disease and developing concerns about antimicrobial resistance.

Articles in the next section review management of specific infections during pregnancy. Bacterial vaginosis is a common alteration in the vaginal flora and is increasingly recognized as an important contributor to preterm birth. Dr. Yudin presents an update regarding the optimal strategies for diagnosis, screening, and management of this complication. Drs. Hollier and Workowski review the management of STDs during pregnancy and highlight new changes in the Centers of Disease Control and Prevention Guidelines for the Treatment of Sexually Transmitted Diseases. Herpes simplex virus infections affect approximately one fifth of the United States population, but many infected individuals remain undiagnosed. Drs. Hill and Roberts review new diagnostic techniques and their application for pregnant patients. They also discuss the latest research regarding management of the patient with a history of genital infection and the prevention of neonatal herpes. Drs. Hollier and Grissom address the latest research regarding prenatal diagnosis of cytomegalovirus infections and also review complications associated with Epstein-Barr virus and varicella zoster virus infections. Practical management tips and algorithms are included. A clinically oriented guide for the diagnosis and management of pregnancies with possible and confirmed infection with human parvovirus B19 is provided by Drs. Ramirez and Mastrobattista. Dr. Montoya is one of the leading experts in the United States in the diagnosis and management of pregnancies complicated by Toxoplasma gondii infection. He and Dr. Rosso provide a well-organized plan for maternal and fetal testing and subsequent intervention. They present new information to help the clinician in the difficult situation of deciding which pregnancies are truly at risk for fetal toxoplasmosis.

Drs. Laibl and Sheffield review two important infections with pulmonary manifestations: influenza and tuberculosis. They review important changes in the recommendations for influenza vaccination during pregnancy and discuss appropriate therapeutic interventions. Strategies for evaluation of the asymptomatic patient with tuberculosis exposure and infection are reviewed, as are new recommendations for treatment of women with active disease. Urinary tract infections contribute to preterm birth and may contribute to adverse neurologic outcomes. Optimal management for the pregnant patient with urinary tract infections is presented by Drs. Mittal and Wing. Led by Dr. Jamieson, experts from the Centers for Disease Control and Prevention review important emerging infections including West Nile virus and severe acute respiratory syndrome (SARS).

This issue would not be complete without a discussion of current research involving the association between epidural analgesia and fever during labor. Dr. Alexander presents an excellent discussion of this common occurrence. Drs. Pate and Twickler provide an outstanding overview of radiologic modalities and appropriate use in patients with infections. They emphasize the importance of system-wide protocols for evaluating pregnant women with imaging resources to minimize confusion and streamline care. The issue concludes with an up-to-date guide for antimicrobial use in the prevention and treatment of postoperative pelvic infections written by Dr. Faro.

We would like to thank the contributors for sharing their expertise and experience and providing the readers with timely updates on research and practical clinical information. The authors are all busy physicians or researchers who worked extra hours into already busy schedules to prepare these outstanding articles. We would like to especially thank the editorial staff at Elsevier, particularly Carin Davis for her expert input and for her patience as she guided this project to completion.