How to prevent maternal fetal infections: Interview with Dr. Ana Marbella
There are many infections that can affect the pregnant woman and sometimes they can suppose a risk to the fetus or newborn. Transmission may occur during transplacental pregnancy (congenital infections), during the birth (perinatal infections) and after the birth, through breastfeeding or through contact with maternal secretions (postnatal infections). For this reason it is important a pregestacional medical advice that investigates the health of the pregnant woman and her immune status, to take the appropriate preventive measures to help prevent maternal fetal infections.
Dr. Ana Marbella, obstetrician and gynecologist in the ‘Clínica Medinorte’, ‘Quirónsalud’ and in the ‘Hospital Casa de Salud’ in Valencia, with experience in the care of women during all stages, tells us about maternal fetal infections and how to treat them, so that both mother and baby are healthy.
Dr., what measures do you consider appropriate in the preconception visit?
All women of childbearing age should be vaccinated prior to their pregnancy against rubella, varicella (in cases of negative serology) and hepatitis B. During pregnancy, vaccination against the virus Influenza (flu) is recommended during the cold season and can be vaccinated in any month of pregnancy (not contraindicated). DTP (Diphtheria, Tetanus and Tosferin) vaccination is also recommended during pregnancy in the last trimester and in each pregnancy.
During pregnancy, it is advisable to carry out an analytical serological study of HIV (AIDS), Syphilis (in the first and third trimesters of pregnancy) and Hepatitis B.
Can you tell us in what kind of infections special care is required in terms of food?
Toxoplasmosis and Listeriosis require special mention.
Toxoplasmosis is an infection caused by a protozoan present in the feces of affected cats. It can be spread through the intake of certain vegetables in contact with the soil, as well as by the intake of raw meats from animals raised outdoors. Although congenital toxoplasmosis has a low incidence in our country, primary prevention measures are necessary in those pregnant women who are not immunized. They are advised to avoid eating uncooked meat, be careful with cured meat, to wash hands thoroughly if there is contact with raw meat, to wash fruits and vegetables before consumption and, of course, to avoid contact with cat feces and to wear gloves when gardening.
You have mentioned Listeriosis, what can you tell us about this infection?
It is an infectious disease that has recently acquired almost epidemic character because its incidence in our environment is increasing. The causative bacterium is Listeria monocytogenes, widely distributed in nature in vegetables and forming part of the fecal flora of many animals. The infection is caused by the ingestion of contaminated food (vegetables, milk and dairy products, poultry, meat ...).
Some preventive measures of Listeriosis are: not to eat raw or undercooked meat, not to consume unpasteurized milk, to avoid the consumption of soft cheeses (like Camembert or Roquefort...), sausages and other fast foods, non-canned pates, smoked fishery products requiring refrigeration such as salmon, trout, cod, tuna, mackerel…
It is also recommended to clean the refrigerator often and to quickly consume the products of charcuterie such as ham, turkey and jellies, once opened the container.
Dr., at birth, what type of infectious agent could affect the newborn?
Due to the high incidence of neonatal sepsis due to group B streptococcus (GBS), the detection of GBS (with a vaginal and rectal sampling) is recommended in all pregnant women at the end of pregnancy. Indicating antimicrobial treatment in all mothers, as well as in pregnant women at risk (preterm labor, GBS bacteriuria, intrapartum fever, broken bag of more than 12 hours...).
The gynecological professionals do everything possible to take care of the health of the pregnant women so that both the mother and the baby are healthy. It is therefore essential to have control over the entire pregnancy and the newborn during the first years of life. For the care of the baby, as a doctor I recommend Liip Smart Monitor, an innovative technology that can come very well for all parents because it helps you to know better the health of the baby to be able to detect possible pathologies. It also allows the pediatrician to have complete and objective information of your baby to obtain more accurate diagnoses and help you in the care of baby’s health.
When there are cases of worm infection in a family member, should the pregnant woman be treated equally?
Yes, it is recommended to treat all family members, including pregnant women, when there are cases of infection with worms (pinworms). The proper treatment is Pamoate of pirantel (Trilombrín comp 250 mg), as well as a good hygiene of hands and nails.
Dr., regarding Zika, could you give us some advice?
Given the severity of the congenital Zika, especially microcephaly and severe central nervous system abnormalities, it is important to know which pregnant women are at risk. These types of pregnant women are those who have traveled or lived in an endemic area during pregnancy or up to 8 weeks prior to pregnancy or any non-pregnant woman who has had unprotected sex (up to 8 weeks prior to pregnancy) with a partner from an endemic area. Consult all information from the Centers for Disease Control and Prevention on areas where there is a risk of zika.
Due to Zika is a sexually transmitted virus that can remain in semen it is important to recommend using condoms throughout pregnancy. As a prevention against transmitter mosquito bites, the repellent indicated is RELEC, which will be applied in less than 50% of body surface area.
What vaccines do you recommend for traveling pregnant women?
The ideal would be to avoid travel to endemic areas during pregnancy. But in those cases in which the trip is impossible to cancel, the yellow fever vaccine in the nonimmunized woman is necessary. The rabies vaccine (inactivated vaccine) would also be indicated for travel to high-risk areas in countries at risk of contact with potentially affected animals. And the vaccines of inactivated Hepatitis A (indicated in trips to endemic areas), the meningococcal vaccine (in case of trip to sub-Saharan zone or pilgrimage to Mecca in dry meningitis season from December to June).
Dr., what advice would you give to expectant mothers who have contact with children with exanthematous skin diseases?
First, do not be alarmed at the beginning, keep calm and take the child to the pediatrician for an adequate diagnosis.
There would be no problem with the contact of children with Roseola or Sudden Rash, Infectious Mononucleosis (EBV Ebstein Bar virus), Sdr. Mouth-hand-foot (Coxackie A) or Scarlet fever (Streptococcus group A).
There would be a problem in pregnant women in contact with cases of:
- Chickenpox. As we have mentioned, the best prevention is the vaccine before pregnancy.
- Measles. Unlikely situation since children are usually vaccinated with the triple vaccine (measles, rubella and mumps). But it can be the case of pregnant women who have traveled to countries with deficient vaccination programs with the consequent risk when contacting children with possible disease.
- Rubella. It is also unlikely, but feasible if the unimmunized pregnant woman travels or comes from underdeveloped areas.
- Cytomegalovirus (CMV). It is the most frequent congenital infection, and although it does not meet screening criteria, the pregnant woman has the right to know the disease and to know that the main source of contagion is children under 3 years, saliva and urine. The best measure of primary prevention is very meticulous hygiene with washing hands after contact with saliva, diapers or toys and avoid sharing glasses or utensils with small children. I would recommend pre-pregnancy analytical control in women working in the medical field or in day-care centers to investigate their immune status against CMV.
- Parvovirus (PVB19). It is the virus responsible for the so-called infectious erythema (epidemic Megaeritis or Fifth disease). It affects primary school children with outbreaks early in the spring, and there is a risk of infection in non-immunized pregnant women. There is still no vaccine for this disease. It is recommended that the pregnant woman consults the gynecologist before possible contact with children affected by this disease.
We hope that all the information that Dr. Ana Marbella has given us will help you to know the importance of good advice prior to pregnancy, and to know how to prevent maternal fetal infections that sometimes pose a significant risk to the fetus and newborn. And, of course, always consult any doubts with the gynecologist, who will advise you in this important stage of your life.