Infection Index
Expanded topic list with updated internal and external links.
Common congenital / perinatal topics
Respiratory / foodborne / hematologic
Additional global / less common topics
Detailed References - General Professional Sources
- ACOG Infectious Diseases and Emerging Issues
https://www.acog.org/topics/infectious-diseases - SMFM Infectious Diseases
https://www.smfm.org/infectious-diseases - CDC - Pregnancy and Infections
https://www.cdc.gov/ - NIH Perinatal HIV Guidelines
https://clinicalinfo.hiv.gov/en/guidelines/perinatal - RCOG Green-top Guidelines
https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/ - MomBaby.org OB Algorithms
https://www.mombaby.org/ob-algorithms/ - IDSA Practice Guidelines
https://www.idsociety.org/practice-guideline/
Cytomegalovirus (CMV)
Congenital CMV remains one of the most important congenital viral infections. Prevention counseling, interpretation of maternal serology, and evaluation of fetal findings such as ventriculomegaly, echogenic bowel, growth restriction, or intracranial abnormalities remain central obstetric issues.
Clinical points
- Primary maternal infection carries the greatest concern for congenital infection, but congenital CMV can also occur after nonprimary infection.
- Consider CMV when ultrasound shows ventriculomegaly, intracranial calcifications, echogenic bowel, growth restriction, hepatosplenomegaly, ascites, or hydrops.
- Prevention counseling includes hand hygiene and saliva/urine exposure reduction, especially around toddlers.
- Coordinate maternal-fetal medicine, infectious disease, pediatric infectious disease, and neonatal follow-up when congenital infection is suspected.
Updated links
- ACOG: Cytomegalovirus (CMV) in Pregnancy
- SMFM Consult Series: Diagnosis and antenatal management of congenital CMV infection
- CDC: Cytomegalovirus (CMV)
- CDC clinical overview of CMV and congenital CMV
- MomBaby.org: Maternal CMV serologic screening algorithm
- Perinatology.com: Cytomegalovirus (CMV) in Pregnancy
Detailed References - CMV
- ACOG Practice Bulletin: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy.
ACOG clinical guidance - Society for Maternal-Fetal Medicine Consult Series: Diagnosis and antenatal management of congenital cytomegalovirus infection.
SMFM Consult Series - Rawlinson WD, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017;17(6):e177-e188.
PMID: 28291720 - CDC: CMV and congenital CMV clinical overview.
CDC clinical overview - MomBaby.org: Method and interpretation of maternal CMV serologic screening.
MomBaby protocol - MomBaby.org: Antenatal diagnosis of congenital CMV infection.
MomBaby diagnostic pathway
Hepatitis B Virus (HBV)
Hepatitis B in pregnancy is important because perinatal transmission can lead to chronic HBV infection in the infant. Current practice emphasizes screening during every pregnancy, HBV DNA testing when HBsAg is positive, antiviral prophylaxis for high viral load, and timely newborn immunoprophylaxis.
Clinical points
- Screen all pregnant patients for HBsAg during each pregnancy, preferably early in prenatal care, regardless of vaccination status or prior testing.
- If HBsAg positive, obtain HBV DNA, HBeAg/anti-HBe as appropriate, ALT/liver assessment, and coordinate hepatology or infectious disease follow-up.
- Maternal antiviral therapy is recommended/considered when HBV DNA is greater than 200,000 IU/mL to reduce perinatal transmission risk; tenofovir-based therapy is commonly used.
- Cesarean delivery is not recommended solely to reduce HBV transmission.
- Infants of HBsAg-positive patients should receive hepatitis B vaccine and HBIG as soon as possible after birth, ideally within 12 hours, with completion of the vaccine series and postvaccination serologic testing.
- Breastfeeding is generally compatible with HBV infection when the infant receives appropriate immunoprophylaxis; cracked or bleeding nipples require individualized counseling.
Updated links
Detailed References - Hepatitis B
- ACOG Clinical Practice Guideline: Viral Hepatitis in Pregnancy. Obstet Gynecol. 2023.
ACOG clinical guidance - SMFM Consult Series #69: Hepatitis B in pregnancy: updated guidelines. Am J Obstet Gynecol. 2024.
AJOG full text - CDC: Clinical Overview of Perinatal Hepatitis B.
CDC perinatal HBV overview - CDC: Clinical Guidance for Perinatal Hepatitis B Testing.
CDC testing guidance - WHO: Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy.
WHO recommendation summary - Dionne-Odom J, et al. Treatment and prevention of viral hepatitis in pregnancy. Am J Obstet Gynecol MFM. 2021.
PMC article
Hepatitis C Virus (HCV)
Hepatitis C management in pregnancy focuses on universal screening, confirmation of active infection with HCV RNA, assessment for liver disease and coinfections, avoidance of procedures that may increase fetal blood exposure when feasible, and linkage to curative direct-acting antiviral therapy outside pregnancy unless treatment is part of an appropriate research or specialist-directed protocol.
Clinical points
- Screen all pregnant patients for HCV during each pregnancy. A reactive antibody test should be followed by HCV RNA testing to confirm current infection.
- Assess HIV and HBV status, liver disease, substance-use risks, and need for hepatology or infectious disease referral.
- Direct-acting antivirals are highly effective outside pregnancy, but routine treatment during pregnancy is not yet standard in U.S. guidance.
- Cesarean delivery is not recommended solely to reduce HCV transmission.
- Avoid internal fetal scalp electrodes, early artificial rupture of membranes, and operative vaginal delivery when feasible because these may increase fetal blood exposure.
- Breastfeeding is generally allowed with HCV infection unless nipples are cracked or bleeding, or when there is HIV coinfection or another contraindication.
- Infants require appropriate postnatal HCV testing and linkage to pediatric follow-up.
Updated links
Detailed References - Hepatitis C
- ACOG Clinical Practice Guideline: Viral Hepatitis in Pregnancy. Obstet Gynecol. 2023.
ACOG clinical guidance - SMFM Consult Series #56: Hepatitis C in pregnancy - updated guidelines. Am J Obstet Gynecol. 2021;225:B8-B18.
SMFM consult page
PMID: 34116035 - CDC: Clinical Screening and Diagnosis for Hepatitis C.
CDC HCV screening guidance - CDC: Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children - United States, 2023.
CDC MMWR 2023 - AASLD-IDSA: HCV Guidance: HCV in Pregnancy.
HCVGuidelines.org - Schillie S, et al. CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recomm Rep. 2020.
CDC MMWR 2020
Human Immunodeficiency Virus (HIV)
Current pregnancy management emphasizes universal screening, rapid linkage to treatment, antiretroviral therapy during pregnancy, viral load-guided intrapartum planning, and neonatal prophylaxis.
Clinical points
- Pregnancy should not be a reason to withhold indicated antiretroviral therapy.
- Management depends on maternal viral suppression, resistance history, timing of diagnosis, and neonatal exposure risk.
- Delivery planning and newborn prophylaxis are guided by current NIH perinatal HIV recommendations.
- Immediate linkage to HIV obstetric expertise is appropriate for newly diagnosed patients.
Detailed References - HIV
- Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States.
Full guideline PDF - NIH: What's New in the Perinatal HIV Clinical Guidelines.
NIH update page - NIH: Intrapartum Care for People With HIV.
NIH intrapartum guidance - NIH: Antiretroviral Management of Infants With In Utero, Intrapartum, or Breastfeeding Exposure to HIV.
NIH infant management - ACOG Committee Opinion No. 752: Prenatal and Perinatal Human Immunodeficiency Virus Testing. Obstet Gynecol. 2018.
ACOG committee opinion - Townsend CL, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28(7):1049-1057.
PMID: 24566097
Syphilis
Syphilis in pregnancy remains a major public-health problem because missed diagnosis or delayed treatment can lead to congenital syphilis, stillbirth, fetal growth problems, hydrops, prematurity, and neonatal disease.
Clinical points
- Screen during pregnancy according to current national and local recommendations and repeat screening in higher-risk settings or patients.
- Penicillin remains the essential treatment in pregnancy when maternal syphilis is diagnosed.
- Maternal stage, treatment timing, reinfection risk, and neonatal evaluation affect congenital syphilis risk assessment.
- Coordinate treatment completion, partner management, and public-health reporting when applicable.
Detailed References - Syphilis
- CDC STI Treatment Guidelines: Syphilis During Pregnancy.
CDC pregnancy syphilis guidance - CDC STI Treatment Guidelines: Congenital Syphilis.
CDC congenital syphilis guidance - ACOG Practice Advisory: Screening for Syphilis in Pregnancy (reaffirmed 2025).
ACOG practice advisory - CDC: About Congenital Syphilis.
CDC overview - Korenromp EL, et al. Maternal and congenital syphilis burden and adverse birth outcomes in sub-Saharan Africa and worldwide. PLoS Med. 2019.
PMID: 30917130
Toxoplasmosis
Toxoplasma gondii infection during pregnancy can cause congenital infection, particularly after primary maternal infection. Important prevention counseling includes food safety and avoidance of cat-feces exposure.
Clinical points
- Exposure risk includes undercooked meat, contaminated soil, and contact with cat litter or cat feces.
- Congenital infection classically involves retinochoroiditis, hydrocephalus, and intracranial calcifications, though presentation is variable.
- Maternal serology interpretation can be complex; confirmatory testing may be needed.
- Fetal evaluation may include ultrasound surveillance and targeted specialist consultation.
Detailed References - Toxoplasmosis
- ACOG Practice Bulletin: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy.
ACOG clinical guidance - CDC DPDx: Toxoplasmosis.
CDC diagnostic reference - CDC: People at Increased Risk for Toxoplasmosis.
CDC risk guidance - Dunn D, et al. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet. 1999;353(9167):1829-1833.
PMID: 10359409 - Robert-Gangneux F, Darde ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev. 2012;25(2):264-296.
PMID: 22491772
Parvovirus B19
Parvovirus B19 can cause fetal anemia, hydrops, and pregnancy loss, especially after primary maternal infection. Exposure histories and serologic interpretation remain clinically important.
Clinical points
- Most maternal infections are mild, but fetal complications can occur.
- Evaluate exposed pregnant patients based on symptoms, immunity status, and gestational age.
- When recent maternal infection is confirmed, fetal surveillance may include ultrasound and MCA Doppler assessment for anemia depending on timing and local practice.
- Pregnant patients with household or occupational exposure to infected children may have higher risk of acquisition.
Detailed References - Parvovirus B19
- CDC: Parvovirus B19 in Pregnancy.
CDC pregnancy guidance - CDC: About Parvovirus B19.
CDC overview - MomBaby.org: Maternal Exposure to Parvovirus B19.
MomBaby protocol - Crane JMG, et al. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can. 2014;36(12):1107-1116.
PMID: 25668048 - de Jong EP, et al. Parvovirus B19 infection in pregnancy. J Clin Virol. 2006;36(1):1-7.
PMID: 16488187
Influenza
Influenza can be more severe in pregnancy. Prevention, vaccination, and prompt treatment remain important obstetric priorities.
Clinical points
- Influenza vaccination is recommended during pregnancy.
- Antiviral treatment should not be delayed in pregnant patients with suspected or confirmed influenza when clinically indicated.
- Escalate care quickly for respiratory compromise, pneumonia, or hypoxemia.
- Seasonal recommendations and vaccine product details are updated regularly.
Detailed References - Influenza
- ACOG Practice Advisory: Influenza in Pregnancy: Prevention and Treatment.
ACOG practice advisory - ACOG Committee Statement: Maternal Immunizations.
ACOG maternal immunization guidance - CDC: Influenza vaccine safety during pregnancy.
CDC pregnancy vaccine safety - Rasmussen SA, et al. Effects of influenza on pregnant women and infants. Am J Obstet Gynecol. 2012;207(3 Suppl):S3-S8.
PMID: 22920056 - Memoli MJ, et al. Influenza in pregnancy. Influenza Other Respir Viruses. 2013;7(6):1033-1039.
PMC article
Listeria
Listeriosis may be mild in the pregnant patient yet still cause severe fetal or neonatal harm. Food-safety counseling remains highly relevant.
Clinical points
- Pregnant patients should receive counseling about avoiding higher-risk foods and recognizing symptoms.
- Maternal illness may be nonspecific with fever, myalgias, or gastrointestinal symptoms.
- Pregnancy loss, preterm birth, and neonatal infection can occur even when maternal illness seems mild.
- Check current CDC outbreak alerts when exposure is suspected.
Detailed References - Listeria
- ACOG Committee Opinion: Management of Pregnant Women With Presumptive Exposure to Listeria monocytogenes.
ACOG committee opinion - CDC: People at Increased Risk for Listeria Infection.
CDC risk guidance - CDC: Protect Your Pregnancy from Listeria.
CDC patient handout PDF - MomBaby.org: Listeriosis in pregnancy handout.
MomBaby handout - Mylonakis E, et al. Listeriosis during pregnancy: a case series and review of 222 cases. Medicine (Baltimore). 2002;81(4):260-269.
PMID: 12169881
Varicella (Chickenpox)
Varicella exposure in pregnancy remains important because severe maternal disease and neonatal complications can occur, and vaccination is contraindicated during pregnancy.
Clinical points
- Confirm immunity status when exposure occurs.
- Pregnant patients without evidence of immunity are at higher risk for severe disease.
- Newborn risk is highest when maternal infection develops near delivery.
- Vaccination is for nonpregnant susceptible patients and postpartum catch-up when appropriate.
Detailed References - Varicella
- RCOG Green-top Guideline No. 13: Chickenpox in Pregnancy.
RCOG guideline landing page - RCOG PDF: Chickenpox in Pregnancy (updated 2024 annotations available on current PDF).
RCOG PDF - CDC: Chickenpox clinical overview.
CDC clinical overview - MomBaby.org: Chickenpox in Pregnancy.
MomBaby handout - Enders G, et al. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet. 1994;343(8912):1548-1551.
PMID: 7915144
Other Infections
Bacterial vaginosis
Brucellosis
Chagas disease
Enterovirus
Epstein-Barr virus
Hantavirus
Human papillomavirus (HPV)
Leishmaniasis
Lyme disease
Lymphocytic choriomeningitis virus (LCMV)
Measles
Neisseria meningitidis
Parasites, intestinal tract
Rocky Mountain spotted fever
Rubella
West Nile virus
Detailed References - Additional Infection Topics
- CDC: Measles.
CDC measles - CDC: West Nile Virus.
CDC West Nile virus - CDC: Malaria.
CDC malaria - CDC: Chagas Disease.
CDC chagas - CDC: LCMV.
CDC LCMV - CDC: Lyme disease.
CDC lyme disease - USPSTF: Screening for Bacterial Vaginosis in Pregnancy to Prevent Preterm Delivery.
USPSTF statement
General Resources
Core public-health, specialty-society, and protocol references relevant to infection evaluation and management in pregnancy.
Professional societies and guidelines
Public health and literature resources
Detailed References - Cross-cutting Guidance
- ACOG: Infectious Diseases and Emerging Issues topic page.
ACOG topic page - SMFM: Infectious diseases topic page and emerging threats page.
SMFM infectious diseases
SMFM emerging threats - RCOG: Green-top Guidelines directory.
RCOG guidelines - IDSA: Practice Guidelines index.
IDSA guideline index - MomBaby.org: OB Algorithms directory.
MomBaby algorithms