W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Clin Microbiol Rev. 2024 Jun 13;37(2):e0007323. doi: 10.1128/cmr.00073-23. Epub 2024 Feb 29.
SUMMARYViral infections during pregnancy are associated with significant adverse perinatal and fetal outcomes. Pregnancy is a unique immunologic and physiologic state, which can influence control of virus replication, severity of disease, and vertical transmission. The placenta is the organ of the maternal-fetal interface and provides defense against microbial infection while supporting the semi-allogeneic fetus via tolerogenic immune responses. Some viruses, such as cytomegalovirus, Zika virus, and rubella virus, can breach these defenses, directly infecting the fetus and having long-lasting consequences. Even without direct placental infection, other viruses, including respiratory viruses like influenza viruses and severe acute respiratory syndrome coronavirus 2, still cause placental damage and inflammation. Concentrations of progesterone and estrogens rise during pregnancy and contribute to immunological adaptations, placentation, and placental development and play a pivotal role in creating a tolerogenic environment at the maternal-fetal interface. Animal models, including mice, nonhuman primates, rabbits, and guinea pigs, are instrumental for mechanistic insights into the pathogenesis of viral infections during pregnancy and identification of targetable treatments to improve health outcomes of pregnant individuals and offspring.
摘要
怀孕期间的病毒感染与围产期和胎儿不良结局显著相关。妊娠是一种独特的免疫和生理状态,可影响病毒复制的控制、疾病的严重程度和垂直传播。胎盘是母婴界面的器官,通过耐受免疫反应提供对微生物感染的防御,同时支持半同种异体胎儿。一些病毒,如巨细胞病毒、寨卡病毒和风疹病毒,可以突破这些防御,直接感染胎儿,并产生持久的后果。即使没有直接的胎盘感染,其他病毒,包括流感病毒和严重急性呼吸综合征冠状病毒 2 等呼吸道病毒,仍然会导致胎盘损伤和炎症。怀孕期间孕激素和雌激素的浓度升高,有助于免疫适应、胎盘形成和胎盘发育,并在母婴界面形成耐受环境中发挥关键作用。包括小鼠、非人灵长类动物、兔子和豚鼠在内的动物模型,对于深入了解妊娠期间病毒感染的发病机制以及确定可靶向治疗方法以改善孕妇和后代的健康结果具有重要意义。