PREGNANCY alters the immune system, increasing susceptibility to infections like Pneumocystis jirovecii, an opportunistic fungus known for causing severe pneumonia in immunocompromised individuals. A recent scoping review sheds new light on the underexplored risks of Pneumocystis infection and colonization in pregnant women, raising concerns about potential impacts on neonatal respiratory health.
The review, which followed PRISMA-ScR guidelines, examined 26 studies focusing on Pneumocystis pneumonia and colonization in pregnant women. Of these, 19 studies reported cases of Pneumocystis pneumonia and 7 addressed colonization. While the majority of pneumonia cases in pregnant women were historically linked to HIV infection prior to widespread antiretroviral therapy, more recent reports highlight hematologic malignancies as a key risk factor.
Colonization rates among pregnant women varied significantly across studies, ranging from 5.4% to 46.5%. Though colonization often presents subclinically, it remains an area of concern due to possible vertical transmission and uncharted neonatal consequences. The review found evidence suggesting vertical transmission of Pneumocystis from mother to infant; however, the extent of its impact on neonatal respiratory outcomes remains largely unknown.
These findings emphasize the importance of including Pneumocystis in differential diagnoses when evaluating pneumonia in pregnant patients, particularly those with underlying risk factors like HIV or hematologic malignancies. The review also reinforces the need for continued HIV screening in this population.
Despite these insights, substantial gaps remain in understanding the full clinical implications of Pneumocystis during pregnancy. Further research is needed to clarify the mechanisms and outcomes of vertical transmission and to explore the potential long-term respiratory effects on neonates.
By raising awareness of this overlooked infection in pregnancy, the review calls for heightened vigilance and expanded research efforts to safeguard maternal and neonatal health.
Reference:
Valade S et al. Pneumocystis infection in pregnant women: A scoping review. Curr Opin Infect Dis. 2024;37:57-66.
