Interventions to prevent and manage infections in pregnancy.

Abstract

Introduction: Interventions aimed at preventing and treating maternal infections during the gestational period are of paramount importance. Timely immunizations, screening strategies and management of maternal infections reduce the risk of complications for the developing fetus and play a pivotal role in improving neonatal outcomes.

Summary: We summarize evidence for a total of thirteen interventions, pertaining to the prevention and treatment of maternal infections during the antenatal period, from Every Newborn Series published in The Lancet 2014. We identified the most recent systematic reviews, extracted data from each review, and conducted a sub-group meta-analysis for low-income countries (LICs) and lower-middle income countries (LMICs) for outcomes relevant to neonatal health.

Results: Evidence from LMICs suggests that influenza virus vaccination had no effect on stillbirth, preterm birth, small for gestational age (SGA) or low birthweight (LBW). Insecticide-treated bed nets (ITN) in pregnancy reduced the risk of fetal loss and improved the babies' birthweight. Changing a two-dose intermittent preventive treatment (IPTp) regimen to more frequent IPTp dosing decreased the risk of LBW) and significantly improved babies' birthweight. Addition of antibacterial antibiotic to the IPTp regimen significantly reduced the risk of LBW. Antibiotic treatments for syphilis and chlamydia had a significant effect on LBW. Treatment of documented periodontal disease during pregnancy reduced the risk of LBW. Findings from our papers indicates limited evidence from LMICs, highlighting the pressing need for coordinated efforts to close this gap and strengthen the body of inclusive evidence on prevention and treatment of maternal infections during pregnancy.