#Infection #Pregnancy #Immunization #Immunity
#Vaccination
Pregnancy is a critical period when it comes to
infectious risks, especially in low- and middle-income countries (LMICs).
Maternal infections are responsible for high rates of maternal and neonatal
morbidity, including miscarriages, prematurity, low birth weight, and even
infant death. Despite global prioritization of reducing maternal and neonatal
mortality, 95% of maternal deaths still occur in LMICs, with most being
preventable through appropriate care.
While numerous recommendations exist,
real-world challenges—limited access to healthcare, lack of systematic
screening, low vaccination coverage, and logistical constraints—make it
difficult to implement comprehensive preventive strategies. A lack of reliable
data and protocols tailored to local contexts continues to hinder efforts to
combat these preventable diseases.
In this context, it is crucial to identify and
implement effective, context-appropriate interventions to prevent and treat
infections during pregnancy. Given the diversity of infectious agents
involved—bacteria, viruses, parasites—an integrated approach combining
prevention, early screening, and targeted treatment is needed. The objective of
this study is to identify and evaluate the most effective interventions for
preventing and treating infections during pregnancy, with the goal of improving
maternal and neonatal health outcomes.
Maternal infections: what really works?
Thirteen preventive and management
interventions for infections during pregnancy were selected to identify the
most effective strategies for limiting fetal and neonatal complications while
evaluating their applicability in resource-limited settings.
The interventions are grouped into three main
categories:
- Antenatal Vaccination (tetanus, influenza);
- Screening and Prevention (insecticide-treated nets, intermittent preventive treatment for
malaria, urinary screening, anthelmintic treatments);
- Targeted Treatment
(antibiotics for syphilis, chlamydia, bacterial infections, and treatment
of periodontal diseases).
Unlike influenza vaccination, tetanus
vaccination has shown a significant impact on reducing neonatal mortality,
prematurity, and low birth weight in LMICs.
In terms of prevention and screening, the use of insecticide-treated nets helps
reduce the risk of fetal loss and improves birth weight. Increasing the
frequency of intermittent preventive treatment for malaria (IPTp) significantly
reduces the risk of low birth weight and improves birth weights overall. Adding
an antibiotic to IPTp also shows additional benefits. Furthermore, screening
and treating asymptomatic bacteriuria reduces the incidence of
small-for-gestational-age births, although its impact on prematurity and
neonatal mortality remains unclear. In contrast, anthelmintic treatments have
not demonstrated clear benefits in reducing prematurity or mortality.
Finally, regarding
anti-infective treatments,
targeted antibiotic therapy against syphilis and chlamydia during pregnancy
significantly reduces the risks of prematurity, stillbirth, and low birth
weight. Treatment of periodontal disease also appears effective in reducing low
birth weight, particularly in resource-limited settings. However, treating
bacterial vaginosis has not demonstrated a major benefit in reducing
prematurity or neonatal mortality.
Read next: ACT to the rescue!
Ready or Not: can we end infections?
Maternal infections during pregnancy represent
a major cause of complications, particularly in resource-limited countries.
Despite their impact, these infections often remain underdiagnosed and
undertreated due to the diversity of pathogens, limited access to healthcare,
and logistical difficulties in implementing effective preventive measures.
The aim of this study was to identify the most
relevant interventions to prevent and treat these infections in order to reduce
maternal and neonatal morbidity and mortality.
The results show that the most effective strategies rely on tetanus
vaccination, the use of insecticide-treated nets, increased malaria preventive
treatment, and targeted antibiotic therapy. In contrast, other interventions,
such as influenza vaccination, anthelmintic treatments, or treatment of
bacterial vaginosis, did not demonstrate a significant impact on neonatal
outcomes in LMICs.
However, the widespread adoption of these
measures remains limited due to the small number of studies conducted in
resource-limited countries, protocol heterogeneity, and logistical challenges
faced in the field. Strengthening research, adapting protocols to local
contexts, and coordinating international efforts to fill these gaps are
therefore essential. Optimizing the prevention and management of maternal
infections remains a priority to reduce maternal and infant mortality and to
give newborns the best chances of survival.
Read next: COVID vaccine and pregnancy: a successful bet?
