Women and TORCH Infections

It is important to educate women about these diseases and their risks, optimally prior to pregnancy. Vaccination is available for some of the diseases, and taking precautions to avoid exposure, such as frequent hand washing, can also aid in disease prevention. The best way for a woman to protect her unborn child from congenital diseases is to protect herself.¹

• Worldwide, congenital HIV infection is a major cause of infant and childhood morbidity and mortality, responsible for an estimated 4 million deaths since the start of the HIV pandemic.²
• CMV is the most common virus known to be transmitted during pregnancy, affecting approximately 0.5–1.5% of births.³ Approximately 40% of maternal CMV infections during pregnancy result in congenital infection.⁴
• In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death, an overall perinatal mortality rate of about 40%.⁵

What Causes These In Utero TORCH Infections?
 
A fetus can contract a TORCH infection in utero when the mother is infected and it is carried through her bloodstream to the baby.
 
The developing fetus is especially vulnerable to illness because its immune system is not yet strong enough to permanently fight off infection.
 
Since a baby in utero cannot completely get rid of an infection, the disease remains in its body and can prevent the child's vulnerable organs from developing correctly.⁶

Risk Factors for Congenital Infectious Diseases

Syphilis is one of a number of infectious diseases that can lead to pregnancy complications and cause birth defects in the developing fetus. The impact of the various infectious diseases that can cause complications can range from miscarriage or premature birth to congenital defects including mental disability, blindness, liver, kidney, and cardiovascular disease, and even infant or childhood mortality.
 
Cytomegalovirus (CMV) is a double-stranded DNA herpes virus and represents the most common congenital viral infection. The CMV seropositivity rate increases with age. Geographic location, socioeconomic class, and work exposure are other factors that influence the risk of infection. CMV infection requires intimate contact through saliva, urine, and/or other body fluids. Possible routes of transmission include sexual contact, organ transplantation, transplacental transmission, transmission via breast milk, and blood transfusion (rare).⁷
 
For most TORCH organisms, the initial screening test is based on detection of antibodies to the organism. In general, TORCH infections pose a greater risk to the fetus and neonate if the mother is actively infected during pregnancy. Primary infections (new infections acquired during pregnancy) are generally more damaging than secondary or reactivated infections.

The symptoms and signs of a vertically transmitted infection depend on the individual pathogen. It may cause subtle signs such as an influenza-like illness and may not even be noticed by the mother during the pregnancy. In such cases, the effects may be seen first at birth.
 
Symptoms of a vertically transmitted infection may include fever and poor feeding. The newborn is often small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by vertically transmitted infections. The mother often has a mild infection with few or no symptoms.⁸

Generally, patient history and risk factors guide prenatal and perinatal maternal testing for TORCH organisms. These tests are performed in the first trimester of pregnancy, and neonates may also be tested for specific TORCH organisms based on clinical history.^9,10 For most TORCH organisms, the initial screening test is based on detection of antibodies to the organism.

• Screening for common infectious agents utilizing the TORCH panel may help to prevent many of the potential birth defects, as some of the TORCH infections can be effectively treated if the mother is diagnosed early in her pregnancy.¹¹
   
• Testing for TORCH organisms can identify fetuses and neonates who are at significant risk. Serologic-based TORCH assays can identify infection and facilitate appropriate care, thereby effectively reducing the risk of birth defects and fetal demise.
   
• Prevention: Some of the vertically transmitted infections, such as toxoplasmosis and syphilis, can be effectively treated with antibiotics if the mother is diagnosed early in her pregnancy. Rubella and varicella-zoster can be prevented by vaccinating the mother prior to pregnancy. If the mother has active herpes simplex, delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus. Steps to prevent CMV infection include avoiding an infected child’s urine or saliva and frequent hand washing when feeding and caring for children.^12,13