What are the effects of Coxsackie (Coxsackievirus) infection on the fetus during pregnancy?

Coxsackievirus Effects on the Fetus

Coxsackievirus infection during pregnancy is generally benign for most mothers but can cause severe neonatal disease, intrauterine fetal demise, and potentially congenital anomalies, with the greatest risk occurring when infection is acquired in late pregnancy or the peripartum period.

Maternal Disease Severity

• Maternal Coxsackievirus infections are typically subclinical or produce minimal symptoms in the mother 1
• Both documented cases of Coxsackie B viral meningo-encephalitis in pregnant women resulted in maternal recovery and delivery of healthy babies 2
• A case of Coxsackie B2 infection at 34 weeks gestation presented with fever and vaginal bleeding requiring cesarean section, but both mother and infant recovered fully 3

Fetal and Neonatal Outcomes

Severe Complications

• Intrauterine fetal demise can occur, as documented in a case where Coxsackie A16 infection at 35 weeks resulted in fetal death one week later 4
• Increased neonatal mortality is associated with maternal coxsackievirus infection 1
• Fulminant perinatal coxsackievirus infections can be fatal to newborns, presenting with massive lung involvement and evidence of extrapulmonary disease on autopsy 1

Neonatal Manifestations

• Infected neonates may develop tachypnea, bradycardia, cerebral irritation, hepatosplenomegaly, intravascular coagulation, and transient rash 3
• Mild acute pericarditis and hypoxic-ischemic encephalopathy have been documented in affected fetuses 4

Congenital Anomalies

• Growing evidence relates maternal coxsackievirus infection to an increase in congenital anomalies 1
• The specific types and frequency of anomalies remain incompletely characterized in the available literature

Placental Involvement

• Coxsackie A16 infection can cause massive perivillous fibrin deposition (MPFD) involving up to 80% of placental parenchyma, leading to fetal demise 4
• This represents the first documented association between Coxsackievirus and MPFD 4
• Transplacental Coxsackievirus infection is very rare but associated with spontaneous abortion, intrauterine demise, or serious neonatal morbidity 4

Transmission and Timing

• Vertical transmission to the fetus can occur, though the exact mechanism remains unclear 4, 1
• The severity of neonatal disease appears related to timing of maternal infection, with late pregnancy infections posing the greatest risk 1
• Neonatal infection likely occurs through transplacental transmission or exposure during delivery 4, 3

Clinical Management Considerations

• Prevention and isolation of infected individuals are the mainstays of management, as no specific antiviral therapy is available 1
• Clinicians should maintain awareness of potential enteroviral infection in pregnant women presenting with meningo-encephalitis 2
• Appropriate infection control measures should be implemented to prevent cross-infection in neonatal units 2
• Coxsackievirus should be considered in the differential diagnosis of febrile illness during pregnancy, particularly in late gestation 3

Key Clinical Pitfall

The most critical pitfall is underestimating the potential severity of neonatal disease despite minimal or absent maternal symptoms—maternal infection may be subclinical while the neonate develops fulminant, life-threatening disease 1.