Infections in pregnancy: Recent therapeutic advances

Bacterial, viral and parasitic infections affect pregnant women, whether they are acute or chronic infections or asymptomatic carriage. Anti-infective drugs allows the treatment of maternal infection, the prevention of mother-to-child transmission, and the treatment of fetuses with congenital infections. Effective treatment of infections such as syphilis and listeriosis has been possible for years with penicillin and listeriosis. New approaches are emerging to detect and treat ascending-route infections from the genital tract to prevent neonatal infections with group B streptococcus and other bacteria. Antiviral therapy, which treats maternal HIV infection, can eliminate its transmission. This concept of preventive treatment now applies to hepatitis B, possibly in the future to hepatitis C. A recent advance is the prevention by an antiviral of mother-to-child transmission of cytomegalovirus in the case of maternal primary infection in the first trimester of pregnancy. Research on anti-infectives during pregnancy is gaining attention. There is a paradox between precautionary warnings (with sometimes improper pictograms) and the practical use of drugs which expose the fetus without careful surveillance. The study of human placental transfer must be systematic, as well as pharmacovigilance using massive data and prospective cohorts. Systematic exclusion of pregnant women from clinical trials is now being challenged when the pathogen is a threat to the mother or child. Most congenital infections result from asymptomatic maternal infections or colonization. In order to achieve secondary prevention, active screening policies are required. The best benefit/risk ratio against infections is primary prevention and vaccination. (c) 2021 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

Bacterial, viral, and parasitic infections have an impact on pregnant women and their fetuses, but treatment and preventive measures using anti-infective drugs can reduce the transmission of infections. Treatment for certain diseases has been well established, but new approaches are needed for detecting and treating emerging infection routes and diseases. Research on the use of anti-infectives during pregnancy is gaining attention, and systematic studies on the placental transfer and drug surveillance are necessary. Active screening policies and vaccination are the most effective methods for preventing infections.