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[肺炎与妊娠]

[Pneumonia and pregnancy].

作者信息

Shalaby A, Lachâtre M, Charlier C

机构信息

Équipe mobile d'Infectiologie, hôpital universitaire Cochin Port-Royal AP-HP, Paris, France.

Équipe mobile d'Infectiologie, hôpital universitaire Cochin Port-Royal AP-HP, Paris, France; Université Paris Cité, Paris, France; Institut Pasteur, Centre national de référence français et Centre collaborateur de l'OMS pour la Listeria, Paris, France; FHU PREMA, Paris, France.

出版信息

Rev Mal Respir. 2025 Feb;42(2):104-116. doi: 10.1016/j.rmr.2025.01.002. Epub 2025 Jan 31.

Abstract

Acute community-acquired pneumonia (CAP) during pregnancy is a frequently encountered and potentially severe condition. CAP incidence and ecology are unchanged during pregnancy as compared with the overall young adult population. Risk factors specifically identified in pregnant women include advanced gestational age, asthma, anemia and repeated courses of corticosteroid therapy for fetal lung maturation. The clinical presentation of CAP is not altered during pregnancy. Key points in the pregnant host encompass: (i) reduced maternal tolerance to hypoxia, due to physiological adaptations during pregnancy; (ii) heightened severity of some infections, notably viral pneumonias such as influenza, varicella or SARS-CoV-2 pneumonia; (iii) potentially deleterious fetal repercussions of infection and maternal hypoxia, with an increased risk of premature delivery and prematurity; (iv) the need for specific attention to the risk of fetal irradiation in the performance of possibly repeated radiological examinations and (v) therapeutic specificities arising from the possible embryo-fetal toxicity of certain anti-infectious agents. CAP prevention is premised on compliance with universal hygiene measures and on vaccination, which guarantees protection against severe forms of pneumonia not only in the mother (Streptococcus pneumoniae, seasonal flu, chickenpox, COVID-19), but also in the child during the first few months of life (whooping cough, RSV).

摘要

妊娠期急性社区获得性肺炎(CAP)是一种常见且可能严重的病症。与总体年轻成年人群相比,妊娠期CAP的发病率和生态学特征并无变化。在孕妇中明确识别出的危险因素包括孕晚期、哮喘、贫血以及为促进胎儿肺成熟而多次使用皮质类固醇治疗。妊娠期CAP的临床表现并无改变。妊娠期宿主的关键点包括:(i)由于孕期的生理适应性变化,母体对缺氧的耐受性降低;(ii)某些感染的严重程度增加,尤其是病毒性肺炎,如流感、水痘或SARS-CoV-2肺炎;(iii)感染和母体缺氧对胎儿可能产生有害影响,早产和不成熟的风险增加;(iv)在可能需要重复进行放射学检查时,需要特别关注胎儿受辐射的风险;(v)某些抗感染药物可能对胚胎-胎儿产生毒性,从而带来治疗上的特殊性。CAP的预防基于遵守普遍的卫生措施和接种疫苗,这不仅能保证母亲(预防肺炎链球菌、季节性流感、水痘、COVID-19)免受严重形式肺炎的侵害,还能在婴儿出生后的头几个月保护其免受百日咳、呼吸道合胞病毒感染。

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