Skip to main content
Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 1997;5(2):165–175. doi: 10.1155/S1064744997000252

Prevention of Infection in Pregnancy

William J Ledger 1,2,✉, Daniel Skupski 1
PMCID: PMC2364562  PMID: 18476170

Abstract

We believe the prevention of infection-related adverse pregnancy outcome is the most important focus for obstetricians today. An emphasis upon immunization of susceptible women, prevention of transmissible disease by modification of patient behavior, and identification and treatment of silent infections should become standards of practice. This will require educational initiatives for physicians and their patients as well as continued clinical trials to determine costs and effectiveness.

Full Text

The Full Text of this article is available as a PDF (932.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander E. R., Harrison H. R. Role of Chlamydia trachomatis in perinatal infection. Rev Infect Dis. 1983 Jul-Aug;5(4):713–719. doi: 10.1093/clinids/5.4.713. [DOI] [PubMed] [Google Scholar]
  2. Amstey M. S., Lewin E., Colaice J. Vaginal colonization with invasive Escherichia coli during pregnancy. Am J Obstet Gynecol. 1980 Jul 1;137(5):534–535. doi: 10.1016/0002-9378(80)90691-2. [DOI] [PubMed] [Google Scholar]
  3. Bobitt J. R., Ledger W. J. Obstetric observations in eleven cases of neonatal sepsis due to the group B beta hemolytic streptococcus. Obstet Gynecol. 1976 Apr;47(4):439–442. [PubMed] [Google Scholar]
  4. Breinig M. K., Kingsley L. A., Armstrong J. A., Freeman D. J., Ho M. Epidemiology of genital herpes in Pittsburgh: serologic, sexual, and racial correlates of apparent and inapparent herpes simplex infections. J Infect Dis. 1990 Aug;162(2):299–305. doi: 10.1093/infdis/162.2.299. [DOI] [PubMed] [Google Scholar]
  5. Brown Z. A., Selke S., Zeh J., Kopelman J., Maslow A., Ashley R. L., Watts D. H., Berry S., Herd M., Corey L. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997 Aug 21;337(8):509–515. doi: 10.1056/NEJM199708213370801. [DOI] [PubMed] [Google Scholar]
  6. Butler J. C., Hofmann J., Cetron M. S., Elliott J. A., Facklam R. R., Breiman R. F. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States: an update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System. J Infect Dis. 1996 Nov;174(5):986–993. doi: 10.1093/infdis/174.5.986. [DOI] [PubMed] [Google Scholar]
  7. Centers for Disease Control (CDC) Increase in rubella and congenital rubella syndrome--United States, 1988-1990. MMWR Morb Mortal Wkly Rep. 1991 Feb 15;40(6):93–99. [PubMed] [Google Scholar]
  8. Centers for Disease Control and Prevention (CDC) Update: trends in AIDS incidence, deaths, and prevalence--United States, 1996. MMWR Morb Mortal Wkly Rep. 1997 Feb 28;46(8):165–173. [PubMed] [Google Scholar]
  9. Crombleholme W. R., Schachter J., Grossman M., Landers D. V., Sweet R. L. Amoxicillin therapy for Chlamydia trachomatis in pregnancy. Obstet Gynecol. 1990 May;75(5):752–756. [PubMed] [Google Scholar]
  10. Demmler G. J. Infectious Diseases Society of America and Centers for Disease Control. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis. 1991 Mar-Apr;13(2):315–329. doi: 10.1093/clinids/13.2.315. [DOI] [PubMed] [Google Scholar]
  11. Elliott B., Brunham R. C., Laga M., Piot P., Ndinya-Achola J. O., Maitha G., Cheang M., Plummer F. A. Maternal gonococcal infection as a preventable risk factor for low birth weight. J Infect Dis. 1990 Mar;161(3):531–536. doi: 10.1093/infdis/161.3.531. [DOI] [PubMed] [Google Scholar]
  12. Eschenbach D. A., Nugent R. P., Rao A. V., Cotch M. F., Gibbs R. S., Lipscomb K. A., Martin D. H., Pastorek J. G., Rettig P. J., Carey J. C. A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. The Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol. 1991 Mar;164(3):734–742. doi: 10.1016/0002-9378(91)90506-m. [DOI] [PubMed] [Google Scholar]
  13. Eschenbach D. A. Ureaplasma urealyticum and premature birth. Clin Infect Dis. 1993 Aug;17 (Suppl 1):S100–S106. doi: 10.1093/clinids/17.supplement_1.s100. [DOI] [PubMed] [Google Scholar]
  14. Faro S. To vaccinate or not to vaccinate. Infect Dis Obstet Gynecol. 1994;2(4):153–153. doi: 10.1155/S1064744994000566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Foulon W., Naessens A., Derde M. P. Evaluation of the possibilities for preventing congenital toxoplasmosis. Am J Perinatol. 1994 Jan;11(1):57–62. doi: 10.1055/s-2007-994537. [DOI] [PubMed] [Google Scholar]
  16. Fouts A. C., Kraus S. J. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980 Feb;141(2):137–143. doi: 10.1093/infdis/141.2.137. [DOI] [PubMed] [Google Scholar]
  17. Franciosi R. A., Knostman J. D., Zimmerman R. A. Group B streptococcal neonatal and infant infections. J Pediatr. 1973 Apr;82(4):707–718. doi: 10.1016/s0022-3476(73)80604-3. [DOI] [PubMed] [Google Scholar]
  18. Gilbert G. L., Hayes K., Hudson I. L., James J. Prevention of transfusion-acquired cytomegalovirus infection in infants by blood filtration to remove leucocytes. Neonatal Cytomegalovirus Infection Study Group. Lancet. 1989 Jun 3;1(8649):1228–1231. doi: 10.1016/s0140-6736(89)92330-1. [DOI] [PubMed] [Google Scholar]
  19. Gill P., Sobeck J., Jarjoura D., Hillier S., Benedetti T. Mortality from early neonatal group B streptococcal sepsis: influence of obstetric factors. J Matern Fetal Med. 1997 Jan-Feb;6(1):35–39. doi: 10.1002/(SICI)1520-6661(199701/02)6:1<35::AID-MFM7>3.0.CO;2-T. [DOI] [PubMed] [Google Scholar]
  20. Gladstone I. M., Ehrenkranz R. A., Edberg S. C., Baltimore R. S. A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J. 1990 Nov;9(11):819–825. doi: 10.1097/00006454-199011000-00009. [DOI] [PubMed] [Google Scholar]
  21. Guerina N. G., Hsu H. W., Meissner H. C., Maguire J. H., Lynfield R., Stechenberg B., Abroms I., Pasternack M. S., Hoff R., Eaton R. B. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med. 1994 Jun 30;330(26):1858–1863. doi: 10.1056/NEJM199406303302604. [DOI] [PubMed] [Google Scholar]
  22. HARRIS R. E., RHOADES E. R. VARICELLA PNEUMONIA COMPLICATING PREGNANCY. REPORT OF A CASE AND REVIEW OF LITERATURE. Obstet Gynecol. 1965 May;25:734–740. [PubMed] [Google Scholar]
  23. Hall R. T., Barnes W., Krishnan L., Harris D. J., Rhodes P. G., Fayez J., Miller G. L. Antibiotic treatment of parturient women colonized with group B streptococci. Am J Obstet Gynecol. 1976 Mar 15;124(6):630–634. doi: 10.1016/0002-9378(76)90065-x. [DOI] [PubMed] [Google Scholar]
  24. Hammerschlag M. R., Cummings C., Roblin P. M., Williams T. H., Delke I. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med. 1989 Mar 23;320(12):769–772. doi: 10.1056/NEJM198903233201204. [DOI] [PubMed] [Google Scholar]
  25. Harris R. E. The significance of eradication of bacteriuria during pregnancy. Obstet Gynecol. 1979 Jan;53(1):71–73. [PubMed] [Google Scholar]
  26. Hillier S. L., Nugent R. P., Eschenbach D. A., Krohn M. A., Gibbs R. S., Martin D. H., Cotch M. F., Edelman R., Pastorek J. G., 2nd, Rao A. V. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995 Dec 28;333(26):1737–1742. doi: 10.1056/NEJM199512283332604. [DOI] [PubMed] [Google Scholar]
  27. Howson C. P., Katz M., Johnston R. B., Jr, Fineberg H. V. Chronic arthritis after rubella vaccination. Clin Infect Dis. 1992 Aug;15(2):307–312. doi: 10.1093/clinids/15.2.307. [DOI] [PubMed] [Google Scholar]
  28. Jeremias J., Draper D., Ziegert M., Jones W., Inglis S., McGregor J. A., Witkin S. S. Detection of Trichomonas vaginalis using the polymerase chain reaction in pregnant and non-pregnant women. Infect Dis Obstet Gynecol. 1994;2(1):16–19. doi: 10.1155/S1064744994000335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Joesoef M. R., Hillier S. L., Wiknjosastro G., Sumampouw H., Linnan M., Norojono W., Idajadi A., Utomo B. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am J Obstet Gynecol. 1995 Nov;173(5):1527–1531. doi: 10.1016/0002-9378(95)90644-4. [DOI] [PubMed] [Google Scholar]
  30. Kimball A. C., Kean B. H., Fuchs F. Congenital toxoplasmosis: a prospective study of 4,048 obstetric patients. Am J Obstet Gynecol. 1971 Sep 15;111(2):211–218. doi: 10.1016/0002-9378(71)90892-1. [DOI] [PubMed] [Google Scholar]
  31. Klebanoff M. A., Regan J. A., Rao A. V., Nugent R. P., Blackwelder W. C., Eschenbach D. A., Pastorek J. G., 2nd, Williams S., Gibbs R. S., Carey J. C. Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. Am J Obstet Gynecol. 1995 May;172(5):1540–1545. doi: 10.1016/0002-9378(95)90493-x. [DOI] [PubMed] [Google Scholar]
  32. Kulhanjian J. A., Soroush V., Au D. S., Bronzan R. N., Yasukawa L. L., Weylman L. E., Arvin A. M., Prober C. G. Identification of women at unsuspected risk of primary infection with herpes simplex virus type 2 during pregnancy. N Engl J Med. 1992 Apr 2;326(14):916–920. doi: 10.1056/NEJM199204023261403. [DOI] [PubMed] [Google Scholar]
  33. Lewin E. B., Amstey M. S. Natural history of group B streptococcus colonization and its therapy during pregnancy. Am J Obstet Gynecol. 1981 Mar 1;139(5):512–515. doi: 10.1016/0002-9378(81)90509-3. [DOI] [PubMed] [Google Scholar]
  34. Licciardi F., Grifo J. A., Rosenwaks Z., Witkin S. S. Relation between antibodies to Chlamydia trachomatis and spontaneous abortion following in vitro fertilization. J Assist Reprod Genet. 1992 Jun;9(3):207–210. doi: 10.1007/BF01203814. [DOI] [PubMed] [Google Scholar]
  35. Linnan M. J., Mascola L., Lou X. D., Goulet V., May S., Salminen C., Hird D. W., Yonekura M. L., Hayes P., Weaver R. Epidemic listeriosis associated with Mexican-style cheese. N Engl J Med. 1988 Sep 29;319(13):823–828. doi: 10.1056/NEJM198809293191303. [DOI] [PubMed] [Google Scholar]
  36. McCabe R., Remington J. S. Toxoplasmosis: the time has come. N Engl J Med. 1988 Feb 4;318(5):313–315. doi: 10.1056/NEJM198802043180509. [DOI] [PubMed] [Google Scholar]
  37. McDuffie R. S., Jr, McGregor J. A., Gibbs R. S. Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcus carriage. Obstet Gynecol. 1993 Oct;82(4 Pt 1):487–489. [PubMed] [Google Scholar]
  38. McGregor J. A., French J. I., Jones W., Milligan K., McKinney P. J., Patterson E., Parker R. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol. 1994 Apr;170(4):1048–1060. doi: 10.1016/s0002-9378(94)70098-2. [DOI] [PubMed] [Google Scholar]
  39. McGregor J. A., French J. I., Seo K. Adjunctive clindamycin therapy for preterm labor: results of a double-blind, placebo-controlled trial. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):867–875. doi: 10.1016/0002-9378(91)90430-y. [DOI] [PubMed] [Google Scholar]
  40. Morales W. J., Schorr S., Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynecol. 1994 Aug;171(2):345–349. doi: 10.1016/s0002-9378(94)70033-8. [DOI] [PubMed] [Google Scholar]
  41. Pass R. F., Hutto C., Ricks R., Cloud G. A. Increased rate of cytomegalovirus infection among parents of children attending day-care centers. N Engl J Med. 1986 May 29;314(22):1414–1418. doi: 10.1056/NEJM198605293142204. [DOI] [PubMed] [Google Scholar]
  42. Pastorek J. G., 2nd, Cotch M. F., Martin D. H., Eschenbach D. A. Clinical and microbiological correlates of vaginal trichomoniasis during pregnancy. The Vaginal Infections and Prematurity Study Group. Clin Infect Dis. 1996 Nov;23(5):1075–1080. doi: 10.1093/clinids/23.5.1075. [DOI] [PubMed] [Google Scholar]
  43. Pastuszak A. L., Levy M., Schick B., Zuber C., Feldkamp M., Gladstone J., Bar-Levy F., Jackson E., Donnenfeld A., Meschino W. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med. 1994 Mar 31;330(13):901–905. doi: 10.1056/NEJM199403313301305. [DOI] [PubMed] [Google Scholar]
  44. Payne N. R., Steinberg S. S., Ackerman P., Chrenka B. A., Sane S. M., Anderson K. T., Fangman J. J. New prospective studies of the association of Ureaplasma urealyticum colonization and chronic lung disease. Clin Infect Dis. 1993 Aug;17 (Suppl 1):S117–S121. doi: 10.1093/clinids/17.supplement_1.s117. [DOI] [PubMed] [Google Scholar]
  45. Pyati S. P., Pildes R. S., Jacobs N. M., Ramamurthy R. S., Yeh T. F., Raval D. S., Lilien L. D., Amma P., Metzger W. I. Penicillin in infants weighing two kilograms or less with early-onset Group B streptococcal disease. N Engl J Med. 1983 Jun 9;308(23):1383–1389. doi: 10.1056/NEJM198306093082303. [DOI] [PubMed] [Google Scholar]
  46. Regan J. A., Chao S., James L. S. Premature rupture of membranes, preterm delivery, and group B streptococcal colonization of mothers. Am J Obstet Gynecol. 1981 Sep 15;141(2):184–186. doi: 10.1016/s0002-9378(16)32589-3. [DOI] [PubMed] [Google Scholar]
  47. Robbins J. B., McCracken G. H., Jr, Gotschlich E. C., Orskov F., Orskov I., Hanson L. A. Escherichia coli K1 capsular polysaccharide associated with neonatal meningitis. N Engl J Med. 1974 May 30;290(22):1216–1220. doi: 10.1056/NEJM197405302902202. [DOI] [PubMed] [Google Scholar]
  48. Rouse D. J., Goldenberg R. L., Cliver S. P., Cutter G. R., Mennemeyer S. T., Fargason C. A., Jr Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: a decision analysis. Obstet Gynecol. 1994 Apr;83(4):483–494. doi: 10.1097/00006250-199404000-00001. [DOI] [PubMed] [Google Scholar]
  49. Rusin P., Adam R. D., Peterson E. A., Ryan K. J., Sinclair N. A., Weinstein L. Haemophilus influenzae: an important cause of maternal and neonatal infections. Obstet Gynecol. 1991 Jan;77(1):92–96. [PubMed] [Google Scholar]
  50. Skoll M. A., Mercer B. M., Baselski V., Gray J. P., Ryan G., Sibai B. M. Evaluation of two rapid group B streptococcal antigen tests in labor and delivery patients. Obstet Gynecol. 1991 Feb;77(2):322–326. doi: 10.1097/00006250-199102000-00035. [DOI] [PubMed] [Google Scholar]
  51. Stagno S., Pass R. F., Dworsky M. E., Henderson R. E., Moore E. G., Walton P. D., Alford C. A. Congenital cytomegalovirus infection: The relative importance of primary and recurrent maternal infection. N Engl J Med. 1982 Apr 22;306(16):945–949. doi: 10.1056/NEJM198204223061601. [DOI] [PubMed] [Google Scholar]
  52. Stevens C. E., Taylor P. E., Tong M. J., Toy P. T., Vyas G. N., Nair P. V., Weissman J. Y., Krugman S. Yeast-recombinant hepatitis B vaccine. Efficacy with hepatitis B immune globulin in prevention of perinatal hepatitis B virus transmission. JAMA. 1987 May 15;257(19):2612–2616. doi: 10.1001/jama.257.19.2612. [DOI] [PubMed] [Google Scholar]
  53. Sánchez P. J. Perinatal transmission of Ureaplasma urealyticum: current concepts based on review of the literature. Clin Infect Dis. 1993 Aug;17 (Suppl 1):S107–S111. doi: 10.1093/clinids/17.supplement_1.s107. [DOI] [PubMed] [Google Scholar]
  54. Wilson C. B., Remington J. S. What can be done to prevent congenital toxoplasmosis? Am J Obstet Gynecol. 1980 Oct 15;138(4):357–363. doi: 10.1016/0002-9378(80)90129-5. [DOI] [PubMed] [Google Scholar]
  55. Witkin S. S., Jeremias J., Toth M., Ledger W. J. Detection of Chlamydia trachomatis by the polymerase chain reaction in the cervices of women with acute salpingitis. Am J Obstet Gynecol. 1993 May;168(5):1438–1442. doi: 10.1016/s0002-9378(11)90778-9. [DOI] [PubMed] [Google Scholar]
  56. Yow M. D., Mason E. O., Leeds L. J., Thompson P. K., Clark D. J., Gardner S. E. Ampicillin prevents intrapartum transmission of group B streptococcus. JAMA. 1979 Mar 23;241(12):1245–1247. [PubMed] [Google Scholar]

Articles from Infectious Diseases in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES