Maternal Origins of Neonatal Infections: What Do Obstetrician–Gynecologist Should/Could Do?

Abstract

Neonatal infections are responsible for 20% of neonatal deaths yearly. In this review, we focused on the origins of the commoner neonatal infections, and we define the role of obstetricians. Regarding group B Streptococcus, a key measure for the prevention of neonatal infection is the vaginal–rectal culture screening at term pregnancy. Intravenous penicillin is the first-line prophylaxis at the start of labor, with intravenous ampicillin as an alternative. First-generation cephalosporins or clindamycin are recommended in case of penicillin allergy. Concerning urinary tract infections (UTIs), guidelines recommend complete urinalysis and urine culture in the first trimester of pregnancy for the screening of asymptomatic bacteriuria. For lower UTIs, guidelines recommend nitrofurantoin as first-choice antibiotic. Amoxicillin or cefalexin are second-line antibiotics. For upper UTIs, guidelines recommend cephalexin per os as first line. Candida spp. colonization affects 20% of pregnant women; however, congenital fetal candidosis and Candida amnionitis are rare. First-line treatment in case of symptomatic vaginitis during pregnancy or asymptomatic colonization during the third trimester is vaginal clotrimazole. Fluconazole is not approved in pregnancy, especially during the first trimester. Genital mycoplasmas colonization during pregnancy is usually asymptomatic and associated with bacterial vaginosis. Colonization is related to neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pneumonia, chorioamnionitis, and sepsis. Macrolides are the first-line treatment along with lactobacillus supplementation. In cases of preterm premature rupture of membranes or preterm labor, ceftriaxone, clarithromycin, and metronidazole are required to prevent intra-amniotic infection. Intra-amniotic infection affects 1 to 5% of deliveries at term and one-third of preterm ones and is associated with perinatal death, early-onset neonatal sepsis, RDS, BPD, pneumonia, meningitis, and prematurity-related diseases. Guidelines recommend a combination of ampicillin and gentamicin, and in case of caesarean section, an additional dose of clindamycin or metronidazole is required. In conclusion, obstetricians should be aware that the treatment of maternal infection during pregnancy can prevent potentially lethal infections in the newborn. Key Points

Significance of cervical secretion culture in predicting maternal and fetal outcome in pregnant women with premature rupture of membranes: a retrospective cohort study

“…Li, et al ( Li et al, 2022 ) sequenced vaginal and cervical secretions from women with normal full-term pregnancy, clinical chorioamnionitis and histological chorioamnionitis, respectively, and showed that these groups had similar cervical microbiological results. Germano, et al, on the other hand, found that vaginal colonisation with Mycoplasma and Mycoplasma Ureaplasma during pregnancy was associated with poor neonatal outcome, whereas there was no significant difference in neonatal outcomes in women with Candida infection ( Germano et al, 2022 ). This also highlights the limited value of cervical secretion culture results alone in predicting chorioamnionitis.…”

Candidiasis in Pregnancy: Relevant Aspects of the Pathology for the Mother and the Fetus and Therapeutic Strategies

“…In addition, it is well noted that a hyperglycemic environment may favor establishment, adhesion, and proliferation of Candida spp. in tissues, vessels, and mucosal surfaces [30]; in fact, there is preclinical evidence that glucose enhances the expression of C3 fungal receptors, that biofilm growth of several pathogens, including Candida spp., has a threshold response to glucose in vitro, and that there is a substantial increase in biofilm production beyond a glucose concentration threshold of 200 to 240 mg/dL [31].…”

“…Regarding therapy in cases of symptomatic disease, the primary treatment for symptomatic vaginitis during pregnancy is vaginal clotrimazole, with a dosage of 500 mg for up to seven days [4,30]. This is particularly recommended during the first trimester due to the observed increased risk of miscarriage [68] and fetal malformations associated with oral fluconazole, including conditions such as fetal cleft lip and transposition of the great vessels [69], and of Fallot's tetralogy [70].…”

“…Oral fluconazole doses ranging from 150 to 300 mg have been deemed safe, starting in the second trimester of gestation, although fluconazole has not received official approval for use during pregnancy [30].…”