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Screening policies during pregnancy

Maria Teresa Neto

- Unidade de Cuidados Intensivos Neonatais, Hospital de Dona Estefânia. Centro Hospitalar de Lisboa Central EPE. Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa. Lisbon, Portugal

- Palestra. Fourth UENPS Meeting. Athens 12/14 December 2014

During pregnancy several illnesses may be screened-genetic disorders, hematologic conditions or infectious diseases. Our attention will focus in infectious diseases. Syphilis continues to be a challenging infection. Despite a cheap diagnosis and treatment continues to be cause of congenital infection in developing world and in some developed countries where it surpass the number of cases of vertical transmission of HIV. This is because more investment was put in the control of HIV. Even though some European countries have no policy concerning HIV screening during pregnancy. Prevalence of HBsAg varies between 0.1 and 4.4 in 16 European countries. In Portugal universal screening during pregnancy started in 1992. In 2000 started vaccination of all people until 18 and all newborn infants. The most successful fight against congenital infections is related with rubella. In Portugal vaccination started in 1984. The prevalence of IgG against rubella is higher than 95% in women of childbearing age. The World Health Organization European Region’s goal is to eliminate rubella and congenital rubella syndrome(CRS) by 2015. Even thought in this century there were 2 cases of CRS in Portugal and 16 in the UK. All countries(28/28) have a nationwide surveillance system for CRS and 26/28 have mandatory report. Concerning toxoplasmosis the disagreement about screening continues. Some countries including Portugal do screening; others do not screen during pregnancy but do it after birth if the newborn is sick(Denmark); others do nothing(UK). The prevalence of IgG against toxoplasmosis in Portuguese pregnant women has been decreasing probably because of primary prevention. CMV primary infection during pregnancy may result in severe consequences for the foetus. Many authors advise screening during pregnancy and even secondary prevention with IV IgG in negative women. In Portugal screening is performed before pregnancy aiming to facilitate diagnosis of congenital infection in case of foetal anomalies. Primary prevention has shown also to be of great efficacy to prevent seroconversion. Europe seems a mosaic with each country having its own policies concerning infectious disease during pregnancy, probably because it is difficult to show the evidence for the correct management of these infections during pregnancy.

Keywords: Infectious diseases, Pregnancy, Screening policies.