ON its own, pregnancy can be a naturally complicated journey. However, there are some medical challenges that may not only put your pregnancy at risk, but can also cause harm to the foetus. Some of the common culprits, according to obstetrician-gynaecologist Dr Robyn Khemlani, are Sexually Transmitted infections (STIs).
“A sexually transmitted infection is an infection spread by sexual contact (whether vaginal, anal or oral) through body fluids such as semen and blood. There are many STIs including HIV, syphilis, hepatitis B and C, herpes, chlamydia, gonorrhoea, human papillomavirus (HPV) and trichomonas to name a few, and these can cause long-term health problems, increase the likelihood of pregnancy complications, and even harm the foetus,” Dr Khemlani explained.
She pointed out that screening for STIs during pregnancy and conducting routine tests throughout the pregnancy is a crucial part of prenatal care because detection and treatment are key to ensure that you are treated and that the foetus is best protected from any adverse outcomes.
Below, Dr Khemlani shares how individual infections, if left untreated, can affect the woman and her foetus, as well as treatments and medical plans that primary care providers often put in place to safeguard the mother and child.
CHLAMYDIA AND GONORRHOEA
Gonorrhoea and chlamydia can both cause health problems in the infant ranging from eye infections to pneumonia. The risk of acquiring chlamydia in an infant born vaginally to a woman with chlamydia is approximately 50 per cent. During pregnancy, the woman is at an increased risk of having a miscarriage, a premature or stillborn child, or one with low birth weight. In addition to preventing these possible complications, there is treatment usually in the form of antibiotics, which prevents transmission to infants during passage through the birth canal, and to prevent future infertility.
“If a woman has syphilis when she is pregnant, the infection can spread to the baby through the placenta. Babies can also become infected during birth. Syphilis may cause miscarriage, pre-term birth, and stillbirth, and it can affect foetal growth and may lead to congenital infection in the neonate,” Dr Khemlani shared. She explained that congenital syphilis is a dangerous infection that babies can get if their mothers have syphilis during pregnancy.
“The term congenital means a condition a person is born with. Congenital syphilis is very serious. It can cause a baby to be born too early or to die before birth,” Dr Khemlani advised.
Preventing and treating syphilis in adults, according to Dr Khemlani, can prevent congenital syphilis.
“One way to prevent congenital syphilis is to make sure that women who get syphilis are treated. Getting treated before getting pregnant is best, but women can still get treated during pregnancy. It is important to get tested after treatment to make sure that the treatment worked,” she advised. Another way of preventing passage is by using latex condoms.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
During pregnancy, HIV can pass through the placenta and infect the foetus. This can also occur during labour and delivery, since the baby may be exposed to the HIV virus in the mother's blood and other fluids.
“When a woman goes into labour, the amniotic sac breaks (her water breaks). Once this occurs, the risk of transmitting HIV to the baby increases. Most babies who get HIV from their mothers become infected around the time of delivery. Breastfeeding also can transmit the virus to the baby,” Dr Khemlani advised.
If, or when diagnosed, Dr Khemlani said that the woman and her doctor will discuss what she can practise to reduce the risk of passing HIV to the baby. This includes taking a combination of anti-HIV drugs during the pregnancy as prescribed, having the baby by caesarean, delivery if lab tests show that the level of HIV is high, taking anti-HIV drugs during labour and delivery as needed, as well as giving anti-HIV drugs to the baby after birth, and avoiding breastfeeding. By following these guidelines, Dr Khemlani said that 99 per cent of HIV-infected women will not pass HIV to their babies.
“If a woman is pregnant and infected with herpes simplex virus (HSV), it can be passed to the foetus during birth while passing through the woman's infected birth canal. This is most likely to occur if a woman first becomes infected with HSV during pregnancy and in a woman who has her first outbreak late in pregnancy,” Dr Khemlani said. However, she explained that it also can occur during a recurrent outbreak in a woman who was infected before pregnancy, although the risk is much lower.
“If you have sores or warning signs of an outbreak at the time of delivery, you may need to have a caesarean delivery to reduce the chance of infection. The decision depends on many factors, including where the sores are on your body and whether the foetus would come into contact with them during delivery,” Dr Khemlani explained
If you have herpes, she said that you should still be able to breastfeed your baby since the herpes virus cannot be passed to a baby through breast milk. However, the baby could get infected by touching a sore on your body.
“Make sure any sores that the baby could come into contact with are covered when you hold your baby or while breastfeeding. Wash your hands with soap and water before and after feeding your baby. If you have sores on your breast, you should not breastfeed your baby from that breast,” Dr Khemlani advised.
Hepatitis B can cause harm, both to the expectant mother and foetus. Unfortunately, Dr Khemlani said that pregnant women may not even know that they are infected because infection sometimes causes no signs or symptoms.
“About 90 per cent of pregnant women with acute hepatitis B virus infection will pass the virus to their babies and between 10 per cent and 20 per cent of women with chronic infection will too,” Dr Khemlani said
She explained that the Hepatitis B virus infection, which can be severe in babies, can threaten their lives. In addition to this, infected newborns have a high risk (up to 90 per cent) of becoming carriers. This means that they, too, can pass the virus to others.
“Hepatitis B infection does not affect how you will give birth, as such you still can have a vaginal delivery. If the child is infected, when he/she becomes an adult, however, he/she has a 25 per cent risk of dying of cirrhosis of the liver or liver cancer,” the ObGyn shared. She said to prevent against these possibilities, once a woman is known to be infected with the hepatitis B virus, her baby will receive certain injections at birth to prevent him/her from becoming infected.
The STIs that are listed above are not the only ones which can cause problems in pregnancy. However, Dr Khemlani recommends that if you are pregnant and you or your partner have had — or may have — a STI, you should inform your doctor.
“The fact is you and your foetus may be at risk; this means you should take advantage of routine prenatal tests because it's the most reliable method for early detection, which with immediate intervention will decrease the chances that your foetus will get the infection,” Dr Khemlani advised. She also said that not just the pregnant woman, but her partner, should also get treated once a STI is discovered, to ensure that re-infection is prevented.
Dr Khemlani also recommends that all pregnant women and their partners use condoms all the time because this is the most effective way of the preventing most STIs.
Dr Robyn Khemlani operates from 10A Parkington Plaza/ 129 Pro/ Westminister Medical Centre and Oxford Medical Centre in Kingston. She can be contacted at firstname.lastname@example.org.