Maternal Infection in Pregnancy: Fetal Risk and Diagnostic Pathway

Quick take: Most maternal infections can be identified early, and with prompt diagnosis and appropriate treatment the risk to the fetus is often low. Your provider will assess the pathogen, timing, and your health status, then follow a step-by-step testing pathway to protect your baby. Understanding the process—from initial symptoms to long-term monitoring—can help you feel more prepared and less anxious if an infection occurs.

It’s 2 a.m., you’ve just felt a sudden shiver and a low‑grade fever, and the thought that something might be harming the tiny life you’re carrying floods your mind. You grab your phone, scroll through a dozen articles, and wonder whether you need to panic or simply schedule a prenatal visit. You’re not alone—many expectant parents experience that exact moment of uncertainty.

In this guide we break down everything you need to know about maternal infection in pregnancy: which infections matter most, how clinicians evaluate fetal risk, which tests are ordered, and what treatments keep both you and your baby safe. We’ll also explore how infections can affect long-term development, what to expect during recovery, and how to advocate for yourself in prenatal care. By the end of the article you’ll have a clear roadmap, a list of warning signs, and practical steps you can take right now.

We’ll start with an overview of the most common viral, bacterial, and parasitic infections, then walk through the risk‑assessment criteria, the diagnostic pathway, management strategies, monitoring plans, prevention tips, and finally the likely outcomes. If you ever need a personalized risk calculation, the Congenital Infection Workup can help you translate the numbers into a clear picture.

Common maternal infections and their fetal implications

Infections can be grouped into three broad categories—viral, bacterial, and parasitic. Each behaves differently in pregnancy, and the timing of exposure often dictates the severity of fetal impact. But it’s not just about the type of infection—your body’s response, the strain of the pathogen, and even environmental factors can play a role.

• Viral infections: Cytomegalovirus (CMV), rubella, herpes simplex virus (HSV), varicella‑zoster, parvovirus B19, and emerging pathogens such as SARS‑CoV‑2. Some, like CMV and rubella, are classic TORCH agents that can cause sensorineural hearing loss, cataracts, or brain malformations when transmitted in the first trimester. For example, CMV is the most common congenital viral infection, affecting about 1 in 200 newborns in the U.S., yet many mothers never realize they’ve been exposed.
• Bacterial infections: Group B Streptococcus (GBS), Listeria monocytogenes, urinary‑tract infections (UTIs) caused by Escherichia coli, and sexually transmitted infections (STIs) such as chlamydia and syphilis. Bacterial sepsis or untreated syphilis can lead to stillbirth, preterm labor, or neonatal infection. GBS, for instance, colonizes the vagina or rectum of about 25% of pregnant women, but with proper screening and intrapartum antibiotics, the risk of transmission drops dramatically.
• Parasitic infections: Toxoplasma gondii, malaria (Plasmodium spp.), and helminths. Toxoplasmosis, another TORCH pathogen, is notorious for causing hydrocephalus and intracranial calcifications if acquired early. The risk of toxoplasmosis varies by region—it’s more common in areas with undercooked meat consumption or outdoor cats, but simple precautions can reduce exposure.

Most infections are asymptomatic or cause mild, flu‑like symptoms in the mother, yet the fetus can be vulnerable because the placenta is not a perfect barrier. The placenta acts as a filter, but some pathogens can cross it, especially if the infection is severe or occurs during critical periods of fetal development. For example, rubella is most dangerous in the first 8 weeks of pregnancy, when the baby’s organs are forming, but becomes less risky as the pregnancy progresses.

It’s also worth noting that not all infections are equally likely to cross the placenta. Some, like HIV, require specific conditions (such as high viral loads or untreated status) to pose a significant risk. Others, like the common cold, rarely affect the fetus at all. Understanding these nuances can help you contextualize the risks and avoid unnecessary anxiety.

How maternal immunity shapes fetal risk

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For example, if you had chickenpox (varicella) as a child, your body retains immunity, and the risk of congenital varicella syndrome is extremely low. Similarly, rubella vaccination before pregnancy provides lifelong protection against congenital rubella syndrome, which can cause severe birth defects. On the other hand, if you’ve never been exposed to CMV, your first infection during pregnancy carries a higher risk of transmission to the fetus.

Your provider may recommend a blood test early in pregnancy to check your immunity status for certain infections, such as rubella, varicella, and hepatitis B. If you’re not immune, they may suggest vaccination (if available) before or after pregnancy, or extra precautions to avoid exposure. For example, women who are not immune to toxoplasmosis may be advised to avoid handling cat litter or eating undercooked meat.

It’s also important to note that your immune system changes during pregnancy. These changes help protect the fetus from being rejected by your body, but they can also make you more susceptible to certain infections, such as the flu or urinary tract infections. This is why vaccination and hygiene measures are especially important during pregnancy.

How to assess fetal risk – key criteria

When a pregnant person presents with an infection, clinicians weigh several variables to estimate fetal risk. The most influential factors are:

1. Gestational age at exposure: The first 12 weeks are the most critical for organogenesis. Infections during this window are more likely to cause structural anomalies. Later exposure may lead to growth restriction, preterm birth, or functional issues. For example, CMV infection in the first trimester is more likely to cause hearing loss or microcephaly, while infection in the third trimester may result in a baby who is small for gestational age.
2. Pathogen type and virulence: TORCH agents, Listeria, and certain viral infections (e.g., rubella) have a higher propensity for vertical transmission and severe outcomes. Some strains of the same pathogen can be more dangerous than others. For instance, not all strains of GBS are equally likely to cause neonatal sepsis, and some strains of E. coli are more resistant to antibiotics.
3. Maternal symptom severity: High fever (> 38.5 °C), prolonged illness, or sepsis increases the chance of fetal hypoxia and inflammatory injury. Fever itself can be harmful to the developing fetus, particularly if it’s high or prolonged. This is why providers often recommend acetaminophen to reduce fever during pregnancy.
4. Maternal immune status: Immunocompromised patients (e.g., HIV, transplant recipients) may harbor higher pathogen loads, raising transmission risk. For example, women with untreated HIV have a much higher risk of transmitting the virus to their babies, but with antiretroviral therapy, the risk drops to less than 1%.
5. Previous immunity or vaccination: Prior rubella immunization, varicella immunity, or CMV seropositivity can dramatically lower the chance of congenital infection. If you’ve been vaccinated or had a prior infection, your body may already have antibodies that protect your baby.

Clinicians combine these factors into a risk matrix, often visualized as a color‑coded chart (low, moderate, high). This matrix guides the intensity of testing, the urgency of treatment, and the frequency of fetal monitoring. For example, a woman with a high fever and a positive CMV IgM in the first trimester would be considered high-risk and may undergo amniocentesis and frequent ultrasounds. In contrast, a woman with a mild UTI in the third trimester might only need oral antibiotics and routine monitoring.

It’s also important to consider the social and environmental context. For example, women who work in healthcare or daycare settings may have a higher risk of exposure to CMV, while those who travel to malaria-endemic regions may need prophylactic medication. Your provider will take these factors into account when assessing your risk.

How infections cross the placenta – the science behind vertical transmission

The placenta is a remarkable organ that nourishes and protects your baby, but it’s not an impenetrable barrier. Some infections can cross the placenta and reach the fetus, a process known as vertical transmission. How this happens depends on the type of pathogen and the stage of pregnancy.

For viruses like CMV and rubella, vertical transmission often occurs when the virus infects the placental cells first. The virus then replicates in the placenta before crossing into the fetal bloodstream. This is why some infections take time to affect the fetus—it’s not just about the mother’s infection, but how the virus interacts with the placenta.

Bacterial infections, like Listeria or syphilis, can cross the placenta more directly, especially if the mother has a high bacterial load or sepsis. Listeria, for example, can invade the placenta and cause microabscesses, which may lead to fetal infection or stillbirth. Syphilis can cross the placenta at any stage of pregnancy, which is why universal screening is so important.

Parasitic infections, like toxoplasmosis, can also cross the placenta, particularly if the mother has a primary infection during pregnancy. The parasite can infect the placenta and then spread to the fetus, causing inflammation and damage to developing organs.

Understanding how infections cross the placenta can help you appreciate why timing matters. Infections that occur early in pregnancy, when the placenta is still developing, may have a different impact than those that occur later. It also explains why some infections are more likely to cause structural anomalies (like heart defects or brain malformations) while others may lead to functional issues (like hearing loss or developmental delays).

Screening and diagnostic pathway – step by step

Below is a practical flowchart that most obstetric practices follow. The pathway can be adapted for local resources, but the core steps remain the same. This section will walk you through what to expect at each stage, from your first prenatal visit to specialized testing if an infection is suspected.

1. Initial prenatal visit – universal screening

• Detailed history: Your provider will ask about your travel history, animal exposure, food habits, sexual history, vaccination record, and any prior infections. For example, if you’ve traveled to a region with Zika virus, they may recommend testing even if you don’t have symptoms. They’ll also ask about any recent illnesses or exposures, such as a family member with chickenpox or a coworker with the flu.
• Baseline labs: These typically include a complete blood count (to check for signs of infection or anemia), urinalysis (to screen for UTIs or protein in the urine), and rapid tests for HIV, hepatitis B, and syphilis (RPR/VDRL). Some providers may also test for immunity to rubella and varicella, especially if you don’t have a vaccination record.
• Vaccination review: Your provider will ensure your tetanus, diphtheria, and pertussis (Tdap) and influenza vaccines are up to date. They’ll also discuss the COVID‑19 booster if you’re eligible. If you’re not immune to rubella or varicella, they may recommend vaccination after delivery, as these are live vaccines and not safe during pregnancy.

This initial visit is also a great time to ask questions about infection prevention. For example, you might want to know whether it’s safe to eat sushi, how to handle cat litter, or what to do if you’re exposed to someone with the flu. Your provider can give you personalized advice based on your risk factors.

2. Targeted testing when symptoms arise

If you report fever, rash, urinary symptoms, or respiratory complaints, your provider will order pathogen‑specific tests. The goal is to identify the infection quickly so treatment can begin. Here’s what you might expect:

1. Serology (IgM/IgG): This blood test checks for antibodies to specific infections, such as CMV, toxoplasmosis, rubella, and parvovirus B19. IgM antibodies indicate a recent infection, while IgG antibodies show past exposure or immunity. For example, if your IgM for toxoplasmosis is positive, it suggests you’ve been recently infected, and your provider may recommend further testing, such as an amniocentesis.
2. Polymerase chain reaction (PCR): This is the most sensitive method for detecting viral RNA or DNA. PCR can be performed on blood, urine, or amniotic fluid. For example, if you have symptoms of COVID-19, your provider may order a nasal swab PCR to confirm the diagnosis. PCR is also used to test amniotic fluid for CMV or toxoplasmosis if there’s a high suspicion of fetal infection.
3. Culture: This test grows bacteria from a sample (such as urine or a vaginal swab) to identify the specific pathogen. For example, if you have symptoms of a UTI, your provider will order a urine culture to determine which bacteria is causing the infection and which antibiotics will work best. Similarly, a vaginal swab at 35–37 weeks screens for GBS, which can cause neonatal sepsis if not treated during labor.
4. Imaging: Ultrasound is the primary imaging tool in pregnancy. A first-trimester ultrasound assesses fetal anatomy and nuchal translucency, while later scans focus on growth and biophysical profile. If an infection is suspected, your provider may order additional ultrasounds to look for signs of fetal infection, such as calcifications in the brain (a sign of toxoplasmosis or CMV) or hydrops (swelling, which can occur with parvovirus B19).

It’s important to note that not all infections require the same level of testing. For example, a mild UTI may only need a urine culture, while a suspected CMV infection may require serology, PCR, and amniocentesis. Your provider will tailor the testing to your symptoms and risk factors.

3. Invasive diagnostics when indicated

When non‑invasive testing suggests a high‑risk infection, your provider may recommend invasive diagnostics to confirm fetal infection. These procedures carry a small risk of complications, such as miscarriage or preterm labor, so they’re only performed when the benefits outweigh the risks.

• Amniocentesis: This procedure is usually performed after 15 weeks of pregnancy. A thin needle is inserted through your abdomen into the amniotic sac to collect a small amount of amniotic fluid, which is then tested for pathogens like CMV or toxoplasma. Amniocentesis is about 98% accurate for diagnosing fetal CMV infection, but it can’t predict the severity of the baby’s symptoms. The procedure carries a small risk of miscarriage (about 1 in 300 to 1 in 500), so it’s typically reserved for high-risk cases.
• Chorionic villus sampling (CVS): This procedure is offered between 10–12 weeks of pregnancy and involves collecting a small sample of placental tissue. CVS can be used to test for genetic conditions or infections, but it carries a slightly higher miscarriage risk than amniocentesis (about 1 in 100). It’s less commonly used for infection testing because amniocentesis is more reliable for detecting fetal infection.

If you’re offered an invasive diagnostic procedure, your provider will discuss the risks and benefits in detail. They’ll also explain what the results might mean for your pregnancy and your baby’s health. It’s okay to ask questions or take time to think about your decision—this is an important choice, and you should feel comfortable with it.

4. Follow‑up laboratory panel

Even after an initial negative screen, repeat testing may be warranted if symptoms persist or if you’re re‑exposed. For example, CMV serology is typically repeated at 12 weeks gestation to catch seroconversion (when your body starts producing antibodies after a recent infection). Similarly, if you’re exposed to someone with chickenpox, your provider may repeat your varicella IgG to confirm immunity.

Follow-up testing is also important if you’re at high risk for certain infections. For example, women who work in daycare or healthcare settings may be advised to have regular CMV testing, as they’re at higher risk of exposure. Similarly, women who travel to malaria-endemic regions may need repeat testing for malaria if they develop symptoms.

Managing infections to protect the fetus

Once a pathogen is identified, treatment decisions balance maternal health, fetal safety, and the likelihood of vertical transmission. The goal is to treat the infection effectively while minimizing any potential risks to the baby. Here’s what you need to know about the most common treatments and how they work.

Antibiotics for bacterial infections

Bacterial infections are among the most treatable in pregnancy, and prompt antibiotic therapy can significantly reduce the risk of complications. Here’s a closer look at the most common bacterial infections and their treatments:

• UTI (E. coli, Proteus): Urinary tract infections are common in pregnancy due to hormonal changes that relax the urinary tract and make it easier for bacteria to ascend. First-line antibiotics include amoxicillin-clavulanate or nitrofurantoin. Nitrofurantoin is generally safe but should be avoided in the late third trimester due to the risk of hemolytic anemia in the newborn. A 7-day course typically clears the infection and reduces the risk of preterm birth. It’s important to complete the full course of antibiotics, even if your symptoms improve, to ensure the infection is fully treated.
• Group B Streptococcus (GBS): GBS is a common bacterium that colonizes the vagina or rectum of about 25% of pregnant women. While it’s usually harmless to the mother, it can cause serious infections in newborns, such as sepsis, pneumonia, or meningitis. To prevent transmission, women who test positive for GBS receive intrapartum antibiotics (usually penicillin G) during labor. If you’re allergic to penicillin, your provider will use an alternative antibiotic, such as cefazolin or clindamycin, based on susceptibility testing. The antibiotics are given intravenously every 4 hours until delivery, which significantly reduces the risk of neonatal infection.
• Listeria: Listeria is a foodborne bacterium that can cause severe illness in pregnant women, including sepsis and meningitis. It can also cross the placenta and cause miscarriage, stillbirth, or neonatal infection. If Listeria is suspected, your provider will prescribe high-dose ampicillin, often combined with gentamicin, for at least 2 weeks. Early treatment markedly improves neonatal outcomes, but the infection can still be serious, so prevention is key. To avoid Listeria, avoid unpasteurized dairy products, deli meats, and refrigerated smoked seafood unless they’re heated to steaming hot.
• Syphilis: Syphilis is a sexually transmitted infection that can cause serious complications in pregnancy, including stillbirth, preterm labor, and congenital syphilis. The good news is that syphilis is easily treated with penicillin, which is safe in pregnancy. The treatment regimen depends on the stage of syphilis and how long you’ve had the infection. For example, early syphilis (less than 1 year) is treated with a single dose of penicillin, while late syphilis (more than 1 year) requires three doses, spaced a week apart. If you’re allergic to penicillin, your provider may recommend desensitization, as penicillin is the only antibiotic proven to treat syphilis effectively during pregnancy.

Antivirals for viral infections

Viral infections are trickier to treat than bacterial infections, but antiviral medications can help reduce the severity of symptoms and lower the risk of transmission to the baby. Here’s what you need to know:

• Herpes simplex virus (HSV): HSV is a common virus that can cause genital or oral herpes. If you have a history of genital herpes, your provider may recommend suppressive therapy with acyclovir (400 mg orally three times daily) starting at 36 weeks to reduce the risk of an outbreak during labor. If you have an active outbreak at the time of delivery, your provider may recommend a cesarean section to reduce the risk of neonatal herpes, which can be life-threatening. Acyclovir is safe in pregnancy and has been used for decades to treat HSV in pregnant women.
• CMV: There is no universally approved antiviral for CMV in pregnancy, but valganciclovir may be offered in severe cases after detailed counseling. Valganciclovir is typically used to treat CMV in immunocompromised patients, and its use in pregnancy is considered experimental. If your provider recommends valganciclovir, they’ll discuss the potential benefits and risks, as well as the limited data on its safety in pregnancy. Most women with CMV infection do not require antiviral therapy, but close monitoring with ultrasounds is recommended to assess fetal growth and development.
• Influenza: Influenza is a respiratory virus that can cause severe illness in pregnant women, particularly in the second and third trimesters. Oseltamivir (Tamiflu) is safe in all trimesters and can shorten the duration of illness if started within 48 hours of symptom onset. It’s also recommended for pregnant women who have been exposed to influenza, even if they don’t have symptoms. The flu vaccine is the best way to prevent influenza during pregnancy, and it’s safe at any gestational age.
• COVID-19: COVID-19 infection during pregnancy is managed with supportive care, such as rest, hydration, and acetaminophen for fever. Antivirals like nirmatrelvir-ritonavir (Paxlovid) may be used in certain cases, but the data on their safety in pregnancy is limited. Your provider will discuss the risks and benefits of antiviral therapy if you test positive for COVID-19. Vaccination remains the most effective way to prevent severe COVID-19 during pregnancy, and the CDC recommends that all pregnant women stay up to date with their COVID-19 vaccines.

Supportive care and adjuncts

In addition to antibiotics and antivirals, supportive care plays a crucial role in managing infections during pregnancy. Here’s what you can do to support your recovery and protect your baby:

• Fever control: Fever is a common symptom of infection, but it can be harmful to the developing fetus, particularly if it’s high or prolonged. Acetaminophen (paracetamol) is the first-line treatment for fever in pregnancy. It’s safe in all trimesters and can help reduce the risk of complications. Ibuprofen should be avoided after 20 weeks of pregnancy because it can affect fetal kidney function and reduce amniotic fluid levels.
• Hydration: Staying hydrated is essential for recovery, especially if you have a fever, vomiting, or diarrhea. Dehydration can lead to preterm labor, so it’s important to drink plenty of fluids. If you’re unable to keep fluids down, your provider may recommend intravenous fluids.
• Rest: Your body needs extra energy to fight off an infection, so rest is crucial. Listen to your body and take it easy until you’re feeling better. If you’re having trouble sleeping due to symptoms like coughing or nasal congestion, talk to your provider about safe remedies.
• Nutrition: Eating a balanced diet can help support your immune system and promote recovery. Focus on nutrient-dense foods like fruits, vegetables, lean proteins, and whole grains. If you’re struggling with nausea or loss of appetite, try small, frequent meals and avoid foods that trigger your symptoms.

Special considerations for emerging pathogens

Emerging pathogens, such as Zika virus or new strains of influenza, can pose unique challenges in pregnancy. Here’s what you need to know about managing these infections:

• Zika virus: Zika virus is a mosquito-borne infection that can cause microcephaly and other birth defects if acquired during pregnancy. There is no specific treatment for Zika virus, so prevention is key. If you’re pregnant or planning to become pregnant, avoid travel to areas with active Zika transmission. If you must travel, take precautions to avoid mosquito bites, such as wearing long sleeves and pants, using insect repellent, and staying in screened or air-conditioned accommodations. If you’re exposed to Zika virus during pregnancy, your provider will recommend regular ultrasounds to monitor fetal growth and development.
• Monkeypox: Monkeypox is a rare viral infection that can cause fever, rash, and swollen lymph nodes. While the risk of monkeypox in pregnancy is low, it can cause complications such as preterm labor or fetal infection. If you’re exposed to monkeypox during pregnancy, your provider may recommend antiviral therapy or immune globulin, depending on your symptoms and risk factors.
• New influenza strains: New strains of influenza can emerge, and pregnant women are at higher risk of severe illness. The flu vaccine is updated annually to protect against the most common strains, so it’s important to get vaccinated every year. If a new strain emerges, your provider may recommend additional precautions, such as antiviral therapy or immune globulin.

Staying informed about emerging pathogens is important, but it’s also important not to panic. Most emerging infections are rare, and the risk to pregnant women is often low. Your provider can help you assess your risk and take appropriate precautions.

Monitoring the pregnancy after infection

Even after successful treatment, careful fetal surveillance is recommended to catch any delayed effects. This section will walk you through what to expect during monitoring, from routine ultrasounds to specialized tests.

Ultrasound schedule

Ultrasound is the primary tool for monitoring fetal growth and development after an infection. The timing and frequency of ultrasounds depend on the type of infection, the gestational age at exposure, and your provider’s recommendations. Here’s a typical schedule:

• First-trimester scan (11–14 weeks): This ultrasound assesses fetal anatomy, measures nuchal translucency (a marker for chromosomal abnormalities), and confirms your due date. If you had an infection in the first trimester, your provider may order additional scans to look for early signs of fetal anomalies, such as calcifications in the brain or heart defects.
• Mid-trimester anatomy scan (18–22 weeks): This is the most detailed ultrasound of pregnancy and assesses all major fetal organs, including the brain, heart, kidneys, and limbs. If you had a TORCH infection, your provider may order a specialized anatomy scan with a maternal-fetal medicine specialist to look for subtle signs of infection, such as microcephaly (small head size) or hydrocephalus (fluid in the brain).
• Growth ultrasounds (every 4 weeks): If you had an infection known to cause intrauterine growth restriction (IUGR), such as syphilis or malaria, your provider may recommend growth ultrasounds every 4 weeks. These scans measure the baby’s head circumference, abdominal circumference, and femur length to ensure they’re growing appropriately. If growth restriction is detected, your provider may recommend additional testing, such as Doppler studies or a biophysical profile.
• Third-trimester scans: In the third trimester, your provider may order additional ultrasounds to monitor fetal well-being, especially if you had a severe infection or complications like preterm labor. These scans may include a biophysical profile (BPP) or Doppler studies to assess blood flow in the umbilical cord and fetal brain.

Biophysical profile (BPP) and Doppler studies

A biophysical profile (BPP) is a non-invasive test that evaluates fetal well-being by assessing five parameters: fetal breathing movements, fetal body movements, fetal tone, amniotic fluid volume, and a non-stress test (which measures the baby’s heart rate in response to movement). Each parameter is scored as 0 (absent) or 2 (present), and the total score ranges from 0 to 10. A score of 8–10 is considered normal, while a score of 6 or below may indicate fetal distress and prompt further evaluation or delivery.

Doppler studies are another tool for assessing fetal well-being. They measure blood flow in the umbilical artery, middle cerebral artery, and other fetal vessels. Abnormal Doppler findings, such as absent or reversed end-diastolic flow in the umbilical artery, can indicate placental insufficiency and may prompt early delivery to prevent stillbirth.

BPP and Doppler studies are typically reserved for high-risk pregnancies, such as those complicated by infection, growth restriction, or preeclampsia. If your provider recommends these tests, they’ll explain what the results mean and how they’ll guide your care.

Neonatal testing

After birth, your baby will be screened for the specific pathogen you were infected with during pregnancy. This testing is important because some infections, like CMV or toxoplasmosis, can cause long-term complications even if the baby appears healthy at birth. Here’s what you can expect:

• CMV: If you had CMV during pregnancy, your baby will be tested for congenital CMV infection using a saliva or urine PCR. If the test is positive, your baby will undergo a hearing test, eye exam, and head ultrasound to assess for signs of infection. Early intervention, such as antiviral therapy or hearing aids, can improve long-term outcomes.
• Toxoplasmosis: If you had toxoplasmosis during pregnancy, your baby will be tested for congenital toxoplasmosis using serology and PCR. If the test is positive, your baby may need treatment with antiparasitic medications, such as pyrimethamine and sulfadiazine, to prevent complications like hydrocephalus or vision loss.
• Syphilis: If you had syphilis during pregnancy, your baby will be tested for congenital syphilis using serology and a physical exam. If the test is positive, your baby will need treatment with penicillin to prevent complications like bone deformities or developmental delays.
• HIV: If you have HIV, your baby will be tested for HIV using PCR at birth, 1–2 months, and 4–6 months. If the test is positive, your baby will need antiretroviral therapy to prevent HIV progression. With early treatment, the risk of HIV transmission can be reduced to less than 1%.

Neonatal testing is an important part of postpartum care, and it can provide peace of mind if the results are negative. If the results are positive, early intervention can make a big difference in your baby’s long-term health.

Long-term developmental follow-up

Some infections, like CMV or rubella, can cause long-term developmental delays even if the baby appears healthy at birth. For this reason, your provider may recommend long-term follow-up with a pediatric specialist, such as a developmental pediatrician or neurologist. Here’s what you can expect:

• Hearing tests: CMV and rubella are leading causes of sensorineural hearing loss in children. Your baby will have a hearing test at birth and may need repeat testing at 6 months and 1 year if they’re at high risk. Early intervention, such as hearing aids or cochlear implants, can improve speech and language development.
• Vision tests: Toxoplasmosis and rubella can cause vision problems, such as cataracts or retinopathy. Your baby will have an eye exam at birth and may need repeat exams if they’re at high risk. Early intervention, such as glasses or surgery, can improve visual outcomes.
• Developmental assessments: Some infections, like CMV or Zika virus, can cause developmental delays, such as motor or cognitive impairments. Your baby will have regular developmental assessments to monitor their progress and identify any areas of concern. Early intervention, such as physical therapy or speech therapy, can help your baby reach their full potential.
• Neurological exams: Infections like toxoplasmosis or HSV can cause neurological complications, such as seizures or cerebral palsy. Your baby will have regular neurological exams to monitor their motor skills, reflexes, and overall development. If any concerns are identified, your provider may recommend additional testing, such as an MRI or EEG.

Long-term follow-up is an important part of caring for a baby who was exposed to an infection during pregnancy. While it can be overwhelming to think about potential complications, early intervention can make a big difference in your baby’s outcomes. Your provider can help you navigate this process and connect you with the resources you need.

Prevention and pre-conception planning

Preventing infection is often easier than treating it. Here are evidence-based steps you can take before and during pregnancy to reduce your risk of infection and protect your baby.

Vaccination schedule

Vaccination is one of the most effective ways to prevent infection during pregnancy. Here’s a breakdown of the vaccines recommended before and during pregnancy, along with their safety and efficacy:

• Tdap (tetanus, diphtheria, pertussis): The Tdap vaccine is recommended between 27–36 weeks of pregnancy to protect your baby from pertussis (whooping cough), which can be life-threatening in newborns. The vaccine is safe in pregnancy and has been shown to reduce the risk of pertussis in infants by about 90%. If you didn’t receive Tdap during pregnancy, you can get it postpartum, and your baby will still receive some protection through breast milk.
• Influenza: The flu vaccine is recommended for all pregnant women at any