Screening for Infection in Pregnancy

The purpose of screening is early diagnosis and treatment of an infection. Screening tests are usually given to people without current symptoms, but who may be at high risk for certain diseases or conditions.

Screening Tests

You will get several screening tests as part of your routine prenatal care. Screening tests can help your doctor know if you are at risk for certain infections during pregnancy. Tests may include:

]]>Amniocentesis]]> —The removal of a small amount of amniotic fluid (the water surrounding a developing baby) from the uterus. While this procedure is usually used to detect genetic problems with the developing baby, it can also help the doctor know if there is an infection present. Amniocentesis has a small risk of ]]>miscarriage]]> , so it is only offered to women with certain risk factors. It is usually performed only if infection of the fetal membranes is suspected.

Blood test —Your blood is checked for the presence of antibodies. Antibodies are proteins that your body has made to fight an infection.

Culture —The doctor will gently swab your vagina, anus, and/or rectum to see if an infection is present. The culture will either be looked at under a microscope in the office or sent to a lab for testing.

]]>Ultrasound]]> —A technician will hold a device over the abdomen that bounces sound waves off the uterus and your developing baby. The sound waves make electrical impulses that create a picture of the baby on a video monitor. This helps the doctor check for any fetal abnormalities that might indicate an infection (usually viral) in the mother.

Urinalysis —This is a test to check for bacteria in the urine. After you urinate into a cup, your healthcare provider will use a specially treated paper strip to check for bacteria in the urine.

Screening Guidelines

The Centers for Disease Control and Prevention (CDC) recommends that pregnant women are screened for sexually transmitted diseases (STDs) on their first prenatal visit. Screening will look for the following STDs:

]]>Bacterial vaginosis]]> (only recommended if you have had a premature delivery in the past)
]]>Chlamydia]]>
]]>Gonorrhea]]>
]]>Hepatitis B]]>
]]>Hepatitis C]]>
]]>HIV]]>
]]>Syphilis]]>

The CDC also recommends that you get screened for ]]>Group B streptococcal disease]]> (GBS) at 35-37 weeks. If the test is positive, you will be given antibiotics to treat this infection during labor.

Pre-pregnancy Checkup

A pre-pregnancy checkup can help you avoid infection in pregnancy and improve the chances of having a healthy baby. At a pre-pregnancy visit, your healthcare provider will ask about your medical history, past pregnancies, and lifestyle. You can ask questions and discuss concerns, such as whether work or hobbies expose you to potential hazards.

Blood tests measure immunity to certain infections. If you have immunity, you cannot get the infection again. If you do not have immunity, you may be able to get a vaccine to protect you from the infection. During a pre-pregnancy visit, you can be checked for:

]]>Chickenpox]]> —Women not immune can be ]]>vaccinated]]> before pregnancy. Conception should be postponed for three months.
]]>Hepatitis B]]> —The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for hepatitis B. Untreated infants of infected mothers have about a 50% risk of getting the virus. Prompt immunization and treatment after birth usually can prevent infection in the baby. However, high-risk women (such as healthcare workers) should consider ]]>vaccination]]> prior to pregnancy.
]]>Rubella (German Measles)]]> —If you are not immune, you can be vaccinated before pregnancy. Conception should be postponed for three months after the ]]>vaccination]]> .
]]>Toxoplasmosis]]> —Some healthcare providers screen for immunity to this infection. Unless a woman knows she is immune, she should not eat undercooked or raw meat or handle cat litter.
]]>Cytomegalovirus (CMV)]]> —Healthcare and childcare workers may want to get tested for CMV before pregnancy to see if they have had CMV in the past. Routine screening for low-risk women is not recommended. If you already have had CMV, you have little cause for concern during pregnancy.
Other Infections —Screenings may find vaginal and ]]>urinary tract infections]]> that may increase the risk of ]]>premature labor]]> .

References:

Apgar BS, Greenberg G, Yen G. Prevention of group B streptococcal disease in the newborn. Am Fam Physician. 2005;71:903-910.

American College of Obstetricians and Gynecologists. Practice bulletin: Perinatal viral and parasitic infections. September 2000.

Avoiding infections in pregnancy. UpToDate Patient Information website. Available at: http://patients.uptodate.com/topic.asp?file=pregnan/2251 . Accessed September 13, 2005.

Bacterial vaginosis during pregnancy. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/bacterialvaginoses.htm . Accessed September 13, 2005.

Chickenpox (varicella). March of Dimes website. Available at: http://www.marchofdimes.com/pnhec/188_675.asp . Accessed September 2, 2005.

Chorioamnionitis. Cleveland Clinic Foundation website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3800/3857.asp?index=12309 . Accessed September 13, 2005.

Cytomegalovirus (CMV) infection. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/diseases/cmv.htm . Accessed September 10, 2005.

Cytomegalovirus infection in pregnancy. March of Dimes website. Available at: http://www.marchofdimes.com/professionals/681_1195.asp . Accessed September 5, 2005.

Group B strep: How to protect your baby. MayoClinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=PR00079 . Accessed September 13, 2005.

Group B streptococcal disease (GBS). National Center for Infectious Diseases website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupbstrep_g.htm . Accessed September 13, 2005.

Herpes during pregnancy: What you should know. American Academy of Family Physicians website. Available at: http://familydoctor.org/760.xml . Accessed September 13, 2005.

Listeria and pregnancy. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancyhealth/listeria.html . Accessed September 13, 2005.

Parvovirus B19 infection and pregnancy. National Center for Infectious Diseases website. Available at: http://www.cdc.gov/ncidod/dvrd/revb/respiratory/B19&preg.htm . Accessed September 13, 2005.

Pregnancy. Hepatitis B Foundation website. Available at: http://www.hepb.org/patients/pregnant_women.htm . Accessed September 13, 2005.

Pre-pregnancy planning. March of Dimes website. Available at: http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=592&page_id=1968128&query=Prenatal+Screening&hiword=PRENATALLY+Prenatal+SCREEN+SCREENED+SCREENINGS+SCREENS+Screening+ . Accessed September 5, 2005

Rubella. March of Dimes website. Available at: http://www.marchofdimes.com/pnhec/188_673.asp . Accessed September 2, 2005.

Schrag SJ, Arnold KE, Mohle-Boetani JC, et al. Prenatal screening for infectious diseases and opportunities for prevention. Obstet Gynecol. 2003;102:753-760.

Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/1-2002TG.htm#SpecialPopulations . Accessed September 5, 2005.

STDs and pregnancy. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/STDFact-STDs&Pregnancy.htm#test . Accessed September 5, 2005.

STDs: Common symptoms and tips on prevention. American Academy of Family Physicians website. Available at: http://familydoctor.org/165.xml . Accessed 9/2/05.

Toxoplasmosis in pregnancy. American Academy of Family Physicians website. Available at: http://familydoctor.org/180.xml . Accessed September 13, 2005.

Urinary tract infection during pregnancy. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/utiduringpreg.html . Accessed September 2, 2005.

Last reviewed June 2007 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.