Carmen De Luca

Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

Use of the Internet by women seeking information about potentially teratogenic agents.

OBJECTIVE The aim of this study was to evaluate if the Internet provides evidence-based information to women seeking information about teratogenic risk factors and womens risk perception. Furthermore, we evaluated the possible risk related to teratogen exposure in the study sample and analysed age, gravidity, educational level, geographic location, marital status and type of exposure compared to a control group made up of women who did not use the Internet to search for teratogen-related information. STUDY DESIGN Between October 2008 and June 2009, a questionnaire was administered to pregnant women calling our Teratology Information Service concerning a suspected teratogenic exposure. RESULTS Fifty-seven percent (n=116) of callers had used the Internet to find medical information about their exposure, while 43% (n=87) had not. Internet users had a medium-high level of education and consulted the Internet because of its convenience, usually early in their pregnancy. We verified the accuracy of the information the women obtained from the Internet and found that 59.5% (n=69) of women received evidence-based answers; 18.1% (n=21) were informed that their exposure was dangerous when it was not; 4.3% (n=5) were wrongly reassured; and the rest (n=18) were not able to interpret the data they found or found no relevant information. CONCLUSIONS Internet use during pregnancy is a widespread phenomenon as the Internet offers the opportunity to share apprehensions and doubts with other women, but it can often lead to increased and unjustified anxiety. Medical information published on websites cannot be considered a substitute for informed medical advice, and patients should not take any action before consulting with a health care professional.

Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women

OBJECTIVE High-risk behaviours are associated with an increased risk of adverse pregnancy outcomes. Exposure to drugs, infection or radiation is a cause of concern for pregnant women, who contact Teratology Information Services (TIS) to have a counseling but with an accurate medical history is possible to detect additional behavioural risk factors that can significantly interfere with pregnancy outcome. The aim of this study is to describe risk behaviours in a population of Italian women calling our TIS and to identify related maternal factors. STUDY DESIGN Between December 2008 and January 2010 we collected data from 503 pregnant women calling our TIS (Telefono Rosso, Rome). We investigated about smoke, alcohol and abuse substances addiction and we also collected demographic data. RESULTS Of the 503 women consenting to participate 34% were found to have an additional risk marker during the current pregnancy. Within this group were 22.7% (n=119) who reported smoking, the 17.7% (n=89) admitted to drink and 2 women (0.4%) used illicit drugs. In 13.7% of cases (n=69) reason for calling represented an exposure to teratogenic agents. Unmarried status and previous induced abortion represent a risk factor for all high-risk behaviours. Lower education (p<0.001) and use of neurological drugs (p<0.001) are related with cigarette consumption. A lower parity was a risk factor for alcohol assumption (p=0.04). Women with high-risk behaviours tend to be exposed to more than a risk factor. CONCLUSIONS Teratogen Information Services are an important system to identify women with pregnancy risk markers. These services should have the ability to provide risk reduction information to women who smoke cigarettes or with alcohol or drug use. In addition to the phone based information these women may benefit from referral back to their physician for assessment and management of substance use/abuse during pregnancy. Substance abuse risks are often underestimated by pregnant women. Single mothers or women with an history of terminations of pregnancy represents an high-risk population. Physicians should inform their patients about possible risks related to high-risk behaviours during preconception counseling or during the first obstetric visit.

Antiepileptic drugs during pregnancy: pharmacokinetics and transplacental transfer.

Epilepsy represents the most common maternal neurological disorder requiring continuous treatment during pregnancy. Maintaining optimum seizure control is an important objective in pregnancy, and the majority of women with epilepsy will need to continue antiepileptic drugs (AEDs). AEDs are frequently used to treat several other conditions, such as headaches and mood disorders. They have been associated with an increased risk of congenital malformations, minor anomalies, congenital syndrome and development disorders. This risk seems to be higher among women using polypharmacy and valproic acid. Neural tube defects are associated with valproic acid and carbamazepine exposure. New AEDs seem to have a less teratogenic effect, but human experience is still limited. The purpose of this review is to provide an update on AED exposure in pregnancy, focusing on pharmacokinetics and transplacental transport.

Screening and management of maternal colonization with Streptococcus agalactiae: an Italian cohort study

Abstract Introduction: Streptococcus agalactiae (Group B streptococcus [GBS]) is the most common cause of sepsis and meningitis in infants <3 months of age. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing the transmission of GBS to newborns. The Centers for Disease Control and Prevention (CDC) guidelines suggest vaginal and rectal cultures to assess GBS colonization between 35 and 37 weeks’ gestation. Methods: Between July and December 2013, we identified 535 women admitted to the Obstetric and Gynecology Unit of Cardarelli Hospital (Campobasso, Italy) for delivery. We evaluated the indications for IAP, complete execution of IAP, and neonatal outcomes. Results: Our sample included 468 women and 475 live births. Correct screening for GBS was executed in 241 cases (51.5%), the number of women colonized was 96 (30.2%), and 136 women had indications to receive IAP, but only 68 (50%) received adequate treatment. Conclusions: GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35–37 weeks’ gestation. Inadequate screening for GBS and incorrect IAP led to an increased incidence of early-onset disease in newborns. Local public health agencies should promote surveillance and educational programs to prevent neonatal GBS infections.

Listeria Infection in Pregnancy: A Review of Literature

Listeria monocytogenes, a Gram-positive bacterium, is responsible for human listeriosis. Infection with Listeria has been associated with the consumption of contaminated and/or inadequately cooked food, particularly dairy products, leafy vegetables, fish, and meat. The main clinical manifestations include diarrhea, nausea and vomiting, which are usually followed by fever and flu-like symptoms. Listeriosis affects pregnant women in about one in seven (14%) cases. They are approximately 10 times more likely to catch the disease than the general population. Although Listeria infection during pregnancy is usually uncomplicated for the mother, fetal and neonatal infection can be severe and fatal. Animal studies have shown a dose-response relationship between L. monocytogenes bacterial load and adverse pregnancy outcome, mainly pregnancy loss. Fetal and neonatal infection occurs through the transplacental passage of the bacterium or through exposure in the perinatal period. In pregnant women Listeria infection was associated with fetal loss, preterm birth, neonatal infection or neonatal death. Blood culture is the principal diagnostic tool and the antibiotic of choice for the treatment of listeriosis is penicillin, with high doses injected intravenously for at least 14 days. In case of suspected or confirmed maternal listeriosis, a program of fetal surveillance should be implemented. Common fetal ultrasound findings in listeria infection include non-immune hydrops, intracranial calcifications, and intrauterine fetal demise. Strategies for the prevention of listeriosis, including avoiding unpasteurized dairy products, uncooked food and leftover food, have significantly decreased the number of cases of infection. Prevention in pregnant women can be achieved by sticking to prophylactic measures and strict diet recommendations.

Prenatal diagnosis, natural history, postnatal treatment and outcome of 222 cases of spina bifida: experience of a tertiary center: Prenatal diagnosis and long-term outcome of 222 cases of fetal Spina Bifida

To report on the prenatal ultrasonographic diagnosis of spina bifida (SB) and its natural history, treatment and long‐term outcome in a large tertiary referral center.

Chronic exposure to high doses of selenium in the first trimester of pregnancy: Case report and brief literature review

Obstetricians usually prescribe supplements during pregnancy without actual indication. The use of selenium during pregnancy has increased, due to its function in several antioxidant mechanisms.

Glaucoma drug therapy in pregnancy: literature review and Teratology Information Service (TIS) case series

BACKGROUND There are many contradictions about pregnancy and fetal/neonatal outcomes after topical use of timolol alone or timolol in combination with other antiglaucoma medications. METHODS Seventy-five pregnant women exposed to antiglaucoma medications were followed prospectively by phone interviews. 27 women used timolol as monotherapy, 48 women used timolol as a part of multidrug therapy. We selected a control group of 187 healthy pregnant women. RESULTS Topical use of timolol alone or timolol in combination with other antiglaucoma medications does not influence pregnancy or fetal/neonatal outcomes. CONCLUSION Beta-blocker is the first choice treatment for glaucoma in pregnancy but, when necessary, multidrug therapy should not to be excluded.