Treatment of respiratory infections in pregnant women
- Lucia Larson, MD
Lucia Larson, MD
- Associate Professor of Medicine
- The Warren Alpert Medical School of Brown University
- Raymond Powrie, MD
Raymond Powrie, MD
- Professor of Medicine and Obstetrics and Gynecology
- Brown Medical School
- Thomas M File, Jr, MD
Thomas M File, Jr, MD
- Professor of Medicine
- Northeast Ohio Medical University
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
The clinical features, diagnosis, and management of respiratory infection are generally similar in pregnant and nonpregnant patients. However, some additional factors need to be considered in pregnancy, including changes in susceptibility to infection, changes in maternal physiology, and the effect of the infection and its treatment on the fetus.
This topic review will discuss issues specific to respiratory infections in the setting of pregnancy. Clinical manifestations, diagnosis, and management of respiratory infections in the general population are reviewed separately (refer to individual topic reviews).
Awareness of pregnancy-associated changes in respiratory physiology is important to the management of respiratory disease in pregnancy (figure 1 and figure 2). Such changes allow the pregnant woman to meet the metabolic needs of her fetus and are discussed in detail elsewhere. (See "Dyspnea during pregnancy", section on 'Respiratory changes'.)
Important points to consider when evaluating pregnant women with respiratory illness include:
●Although pregnant women often experience dyspnea, tachypnea is not normal. The respiratory system adapts to increased needs largely by an increase in tidal volume without an increase in respiratory rate. (See "Dyspnea during pregnancy", section on 'Respiratory changes'.)
- Dennis AT, Solnordal CB. Acute pulmonary oedema in pregnant women. Anaesthesia 2012; 67:646.
- Lim WS, Macfarlane JT, Colthorpe CL. Pneumonia and pregnancy. Thorax 2001; 56:398.
- Maxwell C, McGeer A, Young Tai KF, et al. Management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS). J Obstet Gynaecol Can 2009; 31:358.
- Jamieson DJ, Honein MA, Rasmussen SA, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374:451.
- Figueiró-Filho EA, Oliveira ML, Pompilio MA, et al. Obstetric, clinical, and perinatal implications of H1N1 viral infection during pregnancy. Int J Gynaecol Obstet 2012; 116:214.
- Ramsey PS, Ramin KD. Pneumonia in pregnancy. Obstet Gynecol Clin North Am 2001; 28:553.
- Payne DC, Iblan I, Alqasrawi S, et al. Stillbirth during infection with Middle East respiratory syndrome coronavirus. J Infect Dis 2014; 209:1870.
- Harris AM, Hicks LA, Qaseem A, High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016; 164:425.
- Feldkamp ML, Meyer RE, Krikov S, Botto LD. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study. Obstet Gynecol 2010; 115:109.
- www.reprotox.com (Accessed on January 29, 2013).
- Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007; 45:97.
- Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med 2006; 355:2125.
- Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med 2001; 134:521.
- Lim WS, Macfarlane JT, Colthorpe CL. Treatment of community-acquired lower respiratory tract infections during pregnancy. Am J Respir Med 2003; 2:221.
- Incaudo GA. Diagnosis and treatment of allergic rhinitis and sinusitis during pregnancy and lactation. Clin Rev Allergy Immunol 2004; 27:159.
- Sorri M, Hartikainen-Sorri AL, Kärjä J. Rhinitis during pregnancy. Rhinology 1980; 18:83.
- Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152:S1.
- Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.
- Engels EA, Terrin N, Barza M, Lau J. Meta-analysis of diagnostic tests for acute sinusitis. J Clin Epidemiol 2000; 53:852.
- Bauer ME, Bateman BT, Bauer ST, et al. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg 2013; 117:944.
- Kaunitz AM, Hughes JM, Grimes DA, et al. Causes of maternal mortality in the United States. Obstet Gynecol 1985; 65:605.
- Visscher HC, Visscher RD. Indirect obstetric deaths in the state of Michigan 1960-1968. Am J Obstet Gynecol 1971; 109:1187.
- Menéndez C, Romagosa C, Ismail MR, et al. An autopsy study of maternal mortality in Mozambique: the contribution of infectious diseases. PLoS Med 2008; 5:e44.
- Chen YH, Keller J, Wang IT, et al. Pneumonia and pregnancy outcomes: a nationwide population-based study. Am J Obstet Gynecol 2012; 207:288.e1.
- Khan S, Niederman MS. Pneumonia in the pregnant patient. In: Pulmonary Problems in Pregnancy, Rosene-Montela K, Bourjeily G (Eds), Humana Press, New York 2009. p.177e96.
- Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012; 206:456.
- Gillman LM, Kirkpatrick AW. Portable bedside ultrasound: the visual stethoscope of the 21st century. Scand J Trauma Resusc Emerg Med 2012; 20:18.
- Testa A, Soldati G, Copetti R, et al. Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound. Crit Care 2012; 16:R30.
- Tsung JW, Kessler DO, Shah VP. Prospective application of clinician-performed lung ultrasonography during the 2009 H1N1 influenza A pandemic: distinguishing viral from bacterial pneumonia. Crit Ultrasound J 2012; 4:16.
- Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38:577.
- Bánhidy F, Acs N, Puhó EH, Czeizel AE. Maternal acute respiratory infectious diseases during pregnancy and birth outcomes. Eur J Epidemiol 2008; 23:29.
- Munn MB, Groome LJ, Atterbury JL, et al. Pneumonia as a complication of pregnancy. J Matern Fetal Med 1999; 8:151.
- Yost NP, Bloom SL, Richey SD, et al. An appraisal of treatment guidelines for antepartum community-acquired pneumonia. Am J Obstet Gynecol 2000; 183:131.
- Sheffield JS, Cunningham FG. Community-acquired pneumonia in pregnancy. Obstet Gynecol 2009; 114:915.
- www.reprotox.org (Accessed on September 20, 2012).
- Einarson A, Phillips E, Mawji F, et al. A prospective controlled multicentre study of clarithromycin in pregnancy. Am J Perinatol 1998; 15:523.
- Andersen JT, Petersen M, Jimenez-Solem E, et al. Clarithromycin in early pregnancy and the risk of miscarriage and malformation: a register based nationwide cohort study. PLoS One 2013; 8:e53327.
- Bar-Oz B, Moretti ME, Boskovic R, et al. The safety of quinolones--a meta-analysis of pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2009; 143:75.
- Duong CM, Munns RE. Varicella pneumonia during pregnancy. J Fam Pract 1979; 8:277.
- Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactaton, 9th ed, Lippincott Williams & Wilkins, Philadelphia 2011.
- BASIC PRINCIPLES
- GENERAL APPROACH
- SELECTED DISORDERS AND TREATMENT
- The common cold
- - Hospital acquired and aspiration pneumonia
- Virus-induced wheezing and asthma
- POSTPARTUM ISSUES
- SUMMARY AND RECOMMENDATIONS
- The common cold