Honavar PU
Greetings from the editors as we bring forth the third issue of this year. The month of February is observed as the ‘International Prenatal Infections Prevention’ month. This is to create worldwide awareness of the burden and impact of prenatal infections and to promote measures to improve maternal and neonatal outcome. Prenatal infections are infections that are transmitted to the fetus or newborn during the antenatal period or during delivery. Prenatal infections of obstetric and neonatal significance are viral infections like Human immunodeficiency virus (HIV), Hepatitis B, Hepatitis E, Toxoplasmosis, Rubella, Cytomegalovirus, Herpes, Parvovirus, Varicella Zoster, bacterial infections like Syphilis, Group B Streptococcus, Listeria, tropical diseases like malaria and chronic diseases like tuberculosis to list a few. Around 2 to 3% of congenital anomalies are accountable to prenatal infections. HIV is a sexually transmitted or blood borne virus that affects the T lymphocytes in the body leading to failure of immune system and eventually Acquired Immunodeficiency Syndrome (AIDS). Mother to child transmission is a cause of infection in a newborn. Without treatment, rate of transmission to a newborn is around 15 to 45%. Screening and anti -retroviral treatment in pregnancy has reduced it to less than 5%. Hepatitis B infection can lead to acute or chronic hepatitis, liver cirrhosis or hepatocellular carcinoma. Infection in infancy can lead to high rate of persistent infection and mother to child transmission accounts for approximately 50% of chronic infection cases. Screening for maternal infection and neonatal immunization can reduce the risk of infectivity. Although the incidence of syphilis has reduced over the years, Congenital syphilis is still a cause of early fetal loss, stillbirths, prematurity, neonatal deaths or debilitating conditions like deafness and interstitial keratitis. Serological screening can pick up the infection. Toxoplasmosis, Rubella, Cytomegalovirus, Herpes (TORCH), parvovirus and varicella zoster infections are notorious in pregnancy. They may be asymptomatic or may present as a flu like illness in a mother but have consequences of spontaneous abortions, intrauterine fetal death, growth restriction, congenital anomalies, prematurity, still births or live births with mental retardation, developmental delay, microcephaly, hearing and visual defects. Clinical suspicion, peculiar features on ultrasonography with immunological tests can help in the diagnosis of these infections. Diagnosis, severity of affection and the gestational age can guide in the management of these pregnancies. Fetal medicine expertise can be sought for the same. Listeriosis is a food borne infection caused due to consumption of raw and unprocessed dairy and meat products. Though less prevalent in India, suspicion should be high as when noted can cause fatal fetal or neonatal complications in around 25% cases. Tropical diseases like malaria may have transplacental transmission of the malarial parasites leading to abortions, growth restriction, prematurity and fetal death. Diagnosis based on history and detection of malarial parasites in the peripheral smear or on histopathological examination of placenta and treatment with safe antimalarials is advocated. Another prevalent disease in India is tuberculosis. Vertical transmission is a known mode of transmission leading to growth restriction, low birth weight, failure to thrive and increased risk of neonatal mortality. Prompt diagnosis and accessible treatment through Revised National Tuberculosis Control program (RNTCP) can lead to a better outcome. Recently, awareness of Group B Streptococcal (GBS) infection has gained momentum in the wake of poor maternal and neonatal outcome in women found positive for the organism. Western countries have incorporated it as a part of their antenatal counseling. Most women are asymptomatic carriers. An untreated pregnancy would result in neonatal pneumonia, meningitis, sepsis and mortality. Infant mortality rate is as high as 55%. Intrapartum benzyl penicillin reduces the incidence of early onset GBS disease. Role of GBS is largely unrecognized and underestimated although India is amongst the first five countries in number of pregnant women to be colonized with the bacterium. Controversy exists regarding the ideal preventive strategy and need for universal antenatal screening. At least, women with neonates at the risk of GBS infection need attention. These would include those with preterm births, prolonged rupture of membranes, preterm prolonged rupture of membranes, intrapartum fever, any antenatal maternal culture of GBS or previously affected child. More evidence based studies from the Indian subcontinent can help in framing guidelines for local management. Numerous activities and awareness sessions are conducted across the globe for implementing better policies ultimately with the aim of improving maternal and neonatal wellbeing. Hope our readers are enlightened timely on these topics and help each one of us contribute to a better and healthier society.