Modlin J F
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clin Perinatol. 1988 Jun;15(2):233-46.
Enteroviral infections late in pregnancy are common, especially during periods of high prevalence of community infection. Most of these infections, however, are not associated with significant maternal or neonatal disease. Conversely, as many as 65 per cent of women who give birth to infants with proven enteroviral infection have symptomatic disease during the perinatal period. Maternal echovirus or coxsackievirus B infections are not associated with an increased risk of spontaneous abortions, but stillbirths late in pregnancy have been described. Although a slightly increased risk for congenital heart defects and urogenital anomalies has been reported for the offspring of women who seroconverted to the group B coxsackievirus during pregnancy, these data are highly tentative. Transmission of enteroviruses from mother to infant is relatively common (30-50 per cent) and may occur through contact with maternal secretions during vaginal delivery, blood, or upper respiratory tract secretions. Intrauterine transmission has been documented, but its frequency is unknown. Postnatal transmission from maternal or nonmaternal sources also occurs regularly. Neonatal disease may range from inapparent infection to overwhelming systemic illness and death. Common clinical syndromes associated with neonatal enteroviral infections are meningoencephalitis, pneumonia, myocarditis, and hepatitis. The severity and outcome of perinatally acquired enteroviral infection is influenced by several factors, including the virus strain involved, mode of transmission, and presence of passively acquired serotype-specific maternal antibody. Newborn nursery outbreaks of nonpolio enteroviral infections usually coincide with seasonal peaks of enteroviral disease in the community. These outbreaks have been due mostly to echovirus 11 or group B coxsackievirus serotypes 1 to 5 and are associated with attack rates of up to 50 per cent.
孕期晚期肠道病毒感染很常见，尤其是在社区感染高发期。然而，这些感染大多与严重的母体或新生儿疾病无关。相反，在围产期，多达65%分娩出经证实感染肠道病毒婴儿的女性有症状性疾病。母体埃可病毒或柯萨奇B组病毒感染与自然流产风险增加无关，但有文献描述了孕期晚期的死产情况。尽管有报道称，孕期血清转化为柯萨奇B组病毒的女性后代患先天性心脏缺陷和泌尿生殖系统畸形的风险略有增加，但这些数据很不确定。肠道病毒从母亲传播给婴儿相对常见（30%-50%），可能通过阴道分娩时接触母体分泌物、血液或上呼吸道分泌物发生。宫内传播已有记录，但频率未知。产后从母体或非母体来源的传播也经常发生。新生儿疾病范围可从隐性感染到严重的全身疾病甚至死亡。与新生儿肠道病毒感染相关的常见临床综合征有脑膜脑炎、肺炎、心肌炎和肝炎。围产期获得性肠道病毒感染的严重程度和结果受多种因素影响，包括所涉及的病毒株、传播方式以及被动获得的血清型特异性母体抗体的存在。非脊髓灰质炎肠道病毒感染在新生儿病房的暴发通常与社区肠道病毒疾病的季节性高峰一致。这些暴发大多由埃可病毒11型或柯萨奇B组病毒1至5型血清型引起，发病率高达50%。
