Pregnancy and infection
The New England Journal of Medicine
N Engl J Med. 2014 Jun 5; 370(23): 2211?2218.
Kourtis AP, Read JS, Jamieson DJ
Before the advent of antibiotic agents, pregnancy was a recognized risk factor for severe complications of pneumococcal pneumonia, including death.1 The influenza pandemic of 2009 provided a more recent reminder that certain infections may disproportionately affect pregnant women. Are pregnant women at increased risk for acquiring infections? Are pregnant women with infection at increased risk for severe disease? During pregnancy, several mechanical and pathophysiological changes occur (e.g., a decrease in respiratory volumes and urinary stasis due to an enlarging uterus), and immune adaptations are required to accommodate the fetus. In this article, we review and synthesize new knowledge about the severity of and susceptibility to infections in pregnant women. We focus on the infections for which there is evidence of increased severity or susceptibility during pregnancy that is not fully explained by mechanical or anatomical changes, and we discuss these infections in light of new findings on immunologic changes during pregnancy.