Congenital Infections



Congenital Infections 2357
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Congenital infections affect babies as the result of infection of the mother during pregnancy. Infection of the infant can occur before the infant is born or during the birth process.

KEYWORDS

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Chiamydia

Cytomegalovirus

Gonorrhea

Group B streptococcus

Hepatitis

Herpes

Newborn infections

Parvovirus

Pregnancy infections

Rubella

Syphilis

Toxoplasmosis

Varicella

What Are Congenital Infections?

Bacteria, parasites, or viruses can cause congenital infections, which are infections that are present at birth. These infections can be passed to the fetus or newborn in two ways. Some infections, such as rubella or cyto-megalovirus, are passed from the mother to the baby through the placenta (pluh-SEN-ta), the organ that nourishes the baby in the uterus, or womb. A baby can also become infected during the passage through the birth canal, as happens with group B streptococcus.

Some infections that can seriously endanger the health of a developing fetus or newborn cause few or no symptoms in a pregnant woman. The mother's health and immunity to disease play a role in whether or not she contracts an illness. In addition, the stage during the pregnancy when a woman becomes infected can also affect the severity of the infant's illness. For example, being exposed to an infection in early pregnancy is often more dangerous for the fetus, placing the baby at higher risk for miscarriage * , birth defects, or other problems.

What Are Some Common Congenital Infections?

There are many infections that can be passed from mother to child during pregnancy or childbirth.

Chiamydial Infection

Chlamydial (kla-MIH-dee-ul) infection is a sexually transmitted disease (STD) caused by the bacterium Chlamydia trachomatis (kla-MIH-dee-uh truh-KO-mah-tis). Many women who are infected do not even realize it because they often have no symptoms. However, when untreated, chlamydia can cause a scarring infection of the woman's internal reproductive organs, increasing her risk of a potentially fatal tubal pregnancy * . If passed to the baby during the passage through the birth canal, chlamydia can cause conjunctivitis * and pneumonia * . These infections usually respond well to antibiotic treatment.

Cytomegalovirus

Cytomegalovirus (sye-tuh-meh-guh-lo-VY-rus) infection (CMV) is caused by the cytomegalovirus, a member of the herpesvirus family * . It is transmitted through infected blood, saliva, urine, or other body fluids. CMV is a common infection, affecting about 1 in 100 newborns. Many people who have CMV do not realize it because it often produces no symptoms in healthy adults, but mothers who are infected with the virus during pregnancy can pass the virus to the baby in the uterus. A woman can also pass the virus to her infant during delivery or through breast milk, however, infection by these routes is less likely to cause severe problems for the baby. Newborns who have contracted CMV in the womb may have no initial symptoms, but over the first few years of life the infection has been associated with problems with growth and development, as well as trouble with vision and hearing. About 10 percent of infants with congenital CMV infection will have signs or symptoms at birth that may include jaundice * , retinitis * , microcephaly * , or signs of brain damage. Antiviral medications may help in some cases of congenital CMV infection.

* miscarriage is the ending of a pregnancy through the death of the embryo or fetus before birth.

* tubal (TOO-bal) pregnancy is a condition in which a fertilized egg implants in the fallopian tube instead of the wall of the uterus.

* conjunctivitis (kon-jung-tih-VY-tis), often called 'pinkeye," is an inflammation of the thin membrane that lines the inside of the eyelids and covers the surface of the eyeball. Conjunctivitis can be caused by viruses, bacteria, allergies, chemical irritation, and other conditions or diseases that cause inflammation.

* pneumonia (nu-MO-nyah) is inflammation of the lung.

* herpesvirus (her-peez-VY-rus) family is a group of viruses that can store themselves permanently in the body. The family includes varicella virus, Epstein-Barr virus, and herpes simplex virus.

* jaundice (JON-dis) is a yellowing of the skin, and sometimes the whites of the eyes, caused by a buildup in the body of bilirubin, a chemical produced in and released by the liver. An increase in bilirubin may indicate disease of the liver or certain blood disorders.

* retinitis (reh-tin-EYE-tis) is an inflammation of the retina, the nerve-rich membrane at the back of the eye on which visual images form.

* microcephaly (my-kro-SEH-fah-lee) is the condition of having an abnormally small head, which typically results from an underdeveloped or malformed brain.

Gonococcal infection

Gonorrhea (gah-nuh-REE-uh) is an STD caused by the bacterium Neisseria gonorrhoeae (nye-SEER-e-uh gah-no-REE-eye). Women often do not know that they are infected because the infection may not cause noticeable symptoms. Newborns can be infected during birth and develop an eye infection called gonococcal ophthalmia (gah-nuh-KOH-kul opf-THAL-me-uh). In rare cases, babies will develop gonorrhea that causes blindness or meningitis * . In the United States, newborns routinely receive eye medication at birth to prevent gonococcal eye infection. Antibiotics are given by injection to newborns if gonococcal infection is suspected.

Group B streptococcal infection

Group B streptococcal, or GBS, infection is caused by a bacterium that can be passed from mother to child shortly before or during birth. In newborns it can cause sepsis * , pneumonia, and meningitis. Although most pregnant women with GBS infection have no symptoms, it can cause bladder infections, infections in the womb (known as amnionitis, am-nee-o-NYE-tiss), and stillbirth. GBS disease is the most frequent cause of life-threatening infection in newborns, and according to the U.S. Centers for Disease Control and Prevention (CDC), the rate of infection in newborns is 0.5 per 1,000 live births. Since the beginning of preventive screening and treatment in pregnant women, the number of babies affected by GBS infection has declined by 70 percent. Newborns with GBS infection are treated with intravenous * antibiotics and require hospitalization.

Hepatitis

Hepatitis (heh-puh-TIE-tis) is an inflammation of the liver * . Viruses, bacteria, and a number of other noninfectious medical conditions can cause hepatitis. Hepatitis that is of concern with regard to congenital infection usually is caused by the hepatitis B or C viruses. Both can be transmitted from mother to newborn during birth. If not vaccinated, about 90 percent of newborns infected with hepatitis B at birth will develop chronic * hepatitis, although newborns may not have symptoms of hepatitis at first. In the United States, newborns now routinely receive vaccinations * against hepatitis B infection.

Herpes

Herpes (HER-peez) refers to the infections caused by the two types of herpes simplex virus: HSV-1 and HSV-2. HSV-1 causes cold sores; HSV-2 is sexually transmitted and in women can cause lesions (LEE-zhunz), or sores, on the vagina, cervix * , or skin around the birth canal. The virus can be passed to babies who have contact with these lesions during birth. Herpesvirus infection in newborns can be limited to the skin or it can involve the lungs, brain, and other organs. More widespread infection in the infant can result in permanent brain damage, mental retardation, or death. Newborns with herpes are given intravenous antiviral medication.

* meningitis (meh-nin-JY-tis) Is an inflammation of the meninges, the membranes that surround the brain and the spinal cord. Meningitis is most often caused by infection with a virus or a bacterium.

* sepsis is a potentially serious spreading of infection, usually bacterial, through the bloodstream and body.

* intravenous (in-tra-VEE-nus) means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin's surface directly into a vein.

* liver is a large organ located beneath the ribs on the right side of the body. The liver performs numerous digestive and chemical functions essential for health.

* chronic (KRAH-nik) means continuing for a long period of time.

* vaccinations (vak-sih-NAY-shunz), also called immunizations, are the giving of doses of vaccines, which are preparations of killed or weakened germs, or a part of a germ or product it produces, to prevent or lessen the severity of the disease that can result if a person is exposed to the germ itself.

* cervix (SIR-viks) Is the lower, narrow end of the uterus that opens into the vagina.

Parvovirus

Parvovirus infection is caused by parvovirus B19, which causes fifth disease in children. Fifth disease usually results in a distinctive red rash on the face, body, arms, and legs. Women who are infected during pregnancy typically experience only mild illness, with symptoms such as a rash or joint pain or swelling. However, in some cases the infection can cause severe anemia * in the unborn baby and miscarriage.

Rubella

Rubella (roo-BEH-luh) infection (German measles) is caused by the rubella virus, which is transmitted by contact with fluid from the mouth or nose (usually from coughs or sneezes) of someone who is infected. If a woman contracts the disease early in her pregnancy, she can pass it to her unborn baby. It can lead to congenital rubella syndrome (CRS), which is associated with fetal death, miscarriage, premature delivery, and various birth defects, including deafness, cataracts * , mental retardation, microcephaly, enlarged liver and spleen * , bone marrow * problems, and heart defects. CRS occurs in about 25 percent of infants born to women who had rubella infection during the first 3 months of pregnancy. Babies born with CRS are treated for specific defects.

Syphilis

Syphilis (SIH-fih-lis) is an STD caused by the bacterium Treponema pallidum. If a pregnant woman has syphilis, she can pass it to the fetus. If not treated early, syphilis can lead to serious complications in infants, including blindness, deafness, central nervous system * problems, and death. Nearly half of all infants infected with syphilis during pregnancy die before or shortly after birth, unless the mother has received treatment with antibiotics (usually penicillin) early in the pregnancy. Penicillin is given to infants whose mothers were infected but inadequately treated. Babies who show evidence of possible congenital syphilis, based on either physical signs or the results of a routine newborn blood test that screens infants for exposure to syphilis, also are treated with penicillin.

Toxoplasmosis

Toxoplasmosis (tox-o-plaz-MO-sis) is caused by the parasite Toxoplasma gondii, which is commonly found in cats and can be passed to humans in cat feces * . The March of Dimes estimates that a pregnant woman who contracts toxoplasmosis has a 40 percent chance of passing it to her baby. Handling soiled cat litter is the typical way that the disease is transmitted to humans, but the parasite also may be present in raw or undercooked meat. Women who are first infected with the parasite shortly before they become pregnant or when they are pregnant can pass the organism to the fetus, leading to congenital toxoplasmosis; the symptoms of this condition include jaundice, rash, fever, anemia, inflammation of the retina of the eye, and an enlarged spleen and liver. A baby with congenital toxoplasmosis may be blind or have learning and motor (movement) disabilities and other central nervous system problems. The problems associated with congenital toxoplasmosis may be present at birth or appear as the child develops.

* anemia (uh-NEE-me-uh) is a blood condition in which there is a decreased amount of oxygen-carrying hemoglobin in the blood and, usually, fewer than normal numbers of red blood cells.

* cataracts (KAH-tuh-rakts) are areas of cloudiness of the lens of the eye that can interfere with vision.

* spleen is an organ in the upper left part of the abdomen that stores and filters blood. As part of the immune system, the spleen also plays a role in fighting infection.

* bone marrow is the soft tissue inside bones where blood cells are made.

* central nervous system (SEN-trul NER-vus SIS-tem) is the part of the nervous system that includes the brain and spinal cord.

* feces (FEE-seez) is the excreted waste from the gastrointestinal tract.

Varicella

Infection with the varicella zoster (var-uh-SEH-luh ZOS-ter) virus can cause chicken pox and shingles (an infection that can cause a painful rash with blisters), and it can be spread through contact with the sneezes or coughs of an infected person. Because most adults had chicken pox as children, it is uncommon for a pregnant woman to become infected with the varicella virus. The American College of Obstetricians and Gynecologists estimates that a woman's risk of contracting varicella during pregnancy is less than 1 in 1,000. However, becoming infected during pregnancy can cause serious complications. If a woman is infected with varicella early in the pregnancy, the baby can have multiple birth defects. Features of congenital varicella syndrome may include scarring, malformed limbs, and damage to the eyes and brain. Up to 2 percent of women who become infected with varicella during the first 20 weeks of pregnancy have babies with congenital varicella syndrome. If a mother contracts chicken pox immediately before or after delivery, the baby may develop severe or even fatal chicken pox.

Can Congenital Infections Be Prevented?

There are many preventive steps pregnant women can take to avoid becoming infected with diseases that could harm their infants. Practicing abstinence (not having sex) or safe sex by using a latex condom can reduce the risk of contracting STDs such as syphilis, chlamydia, gonorrhea, and herpes. Experts recommend that every pregnant woman be screened for these infections and, if needed, treated with antibiotics or other medications to reduce the risk of passing them to her baby.

Because between 20 and 30 percent of pregnant women carry GBS bacteria, pregnant women often are tested for the bacteria between the thirty-fifth and thirty-seventh weeks of pregnancy. The woman's doctor takes samples from the vagina and rectum, and the samples are examined under a microscope. If a woman is infected with GBS, intravenous antibiotics given during delivery can help reduce the risk of transmitting the bacteria to her baby.

Avoiding contact with cat feces and not eating or handling raw meat can reduce the risk of contracting toxoplasmosis. Wearing gloves when handling soil, especially outside, and cooking all meat thoroughly before eating can also help prevent infection. Women who are considering becoming pregnant can be screened for antibodies * to CMV and toxoplasmosis. If tests show that they already have antibodies, there is no risk of acquiring the disease during pregnancy and therefore no risk to the baby. If they do not have antibodies, they should practice particularly good hygiene while pregnant, including frequent hand washing, especially after contact with diapers or someone's bodily fluids. Good hygiene can also help prevent infection with parvovirus.

Should Pregnant
Women Receive
Vaccinations?

One way for a woman to prevent pregnancy- and newborn-related infections is to make sure her vaccinations are updated before becoming pregnant. Vaccinations can prevent some diseases, such as rubella and varicella, but if a pregnant woman does not have immunity to these diseases, she should not be vaccinated while pregnant because of potential risk to the fetus (these vaccines contain live viruses). Instead, vaccinating those around her can help protect her from infection. Other vaccines, such as the flu vaccine (not a live virus vaccine), are recommended during pregnancy.

* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.

* immune globulin (ih-MYOON GLAH-byoo-lin), also called gamma globulin, is the protein material that contains antibodies.

Women with herpes lesions will likely have their babies delivered via cesarean section to reduce the risk of passing the virus to the baby during delivery. Administering hepatitis B immune globulin * and hepatitis B vaccine to the infant within 12 hours of birth can prevent hepatitis B infection in the newborn. Experts recommend that rubella and varicella vaccines be given before pregnancy to women who have not already had these diseases or received the vaccines.

Resources

Organizations

March of Dimes, 1275 Mamaroneck Avenue, White Plains, NY 10605. The March of Dimes provides information about how to prevent birth defects, such as those caused by CMV and rubella infection. Telephone 888-MODIMES
http://www.modimes.org

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC is the U.S. government authority for information about infectious and other diseases. The organization offers fact sheets about pregnancy- and newborn-related infections at its website.
Telephone 800-311-3435
http://www.cdc.gov



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