Effects of Vertical Transmission of Respiratory Viruses to the Offspring.
Effects of Vertical Transmission of Respiratory Viruses to the Offspring.
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DOI：
10.3389/fimmu.2022.853009
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发表时间：
2022
影响因子：
7.3
通讯作者：
Piedimonte G
中科院分区：
文献类型：
--
作者：
Manti S;Leonardi S;Rezaee F;Harford TJ;Perez MK;Piedimonte G
妊娠期母体感染显性和亚临床感染可对发育中的胎儿产生多重和显著的病理后果，导致急性围产期并发症和/或整个产后生活中的慢性疾病。在这种情况下，目前的概念怀孕作为一种状态的全身免疫抑制似乎过于简单和过时。毫无疑问，在怀孕期间，母体免疫系统经历了复杂的变化，以建立和维持对胎儿的耐受性，同时仍然保护免受病原体的侵害。除了下调母体免疫力、激素变化和机械适应（例如，肺扩张受限）使孕妇更容易感染呼吸道病原体，如流感病毒、呼吸道合胞病毒（RSV）和严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）。根据感染的病原体和妊娠期间感染的时间，胎儿病理可以从轻度到重度，甚至致命。与一般人群相比，流感与孕妇的发病率和死亡率风险较高有关，特别是在妊娠晚期，母亲因急性心肺疾病住院的风险增加，而其婴儿出现早产、呼吸和神经疾病、先天性异常和新生儿重症监护等并发症的风险更高。宫内RSV暴露与选择性免疫缺陷、发育中呼吸道胆碱能神经支配重塑和气道平滑肌收缩力异常相关，这可能易导致出生后气道炎症和高反应性，以及儿童期慢性气道功能障碍的发生。尽管仍有有限的证据支持SARS-CoV-2垂直传播的发生，但感染SARS-CoV-2的孕妇中早产的高患病率表明，这种病毒可能会改变母胎界面的免疫反应，影响母亲和胎儿。本综述旨在总结关于宫内暴露于流感、RSV和SARS-CoV-2对新生儿和儿科结局的短期和长期后果的现有证据。
Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.