Revisiting Sexually Transmitted Infection Screening and Treatment in Pregnancy.

Aswe enjoy the expert opinion on the importance of sexually transmitted infection (STI) in pregnancy, it is necessary to put this information into the context of the overall pregnancy environment and acknowledge the importance and breadth of prenatal care. Pregnancy is a common occurrence in the United States with over 4 million annual live births; about 14 million births occur worldwide. With this vast number of events, even infrequent diseases become critically important for us to consider for both the mother and the newborn. Cardiovascular diseases and cancer are the leading causes of adult deaths, they deserved the large research effort aimed over the past 50 years at their understanding and treatment. By contrast, studies to prevent complications in pregnancy received only minimal research and attention. In pregnancy, the mother's health is a primary concern and recent increases in US maternal mortality rate underlines the key roles of providers to diagnose and treat hypertension, cardiovascular disease, and diabetes, together with well-known pregnancy complications of hemorrhage and infection. This treatment occurs within a complex system as treatment can be further impacted by reduced access of patients to care and varied education levels that play key roles to deliver optimal maternal health. Most of these complex issues influencing maternal health are identified. However, what we are left with is differences in disease expected among populations with widely different risk levels for any 1 disease. In addition, conditions in pregnancy have a large influence on both the immediate health of the newborn and for many conditions on child health and mortality until the age of 5 years. Further, the impact of the fetal environment on adult disease is increasingly apparent and a wide-spectrum of adult diseases are generated during pregnancy. Maternal hypertension in pregnancy increases not only hypertension but also other cardiovascular disease for both the mother as she ages and for the newborn in adulthood perhaps through hypoxia generating inflammation and oxidative stress. Maternal immunity through maternal influenza and pertussis immunization reduces early neonatal infection from these microbes and, in underdeveloped countries, influenza immunization actively reduces preterm birth. Air pollution from specific air pollutants increases preterm birth and illustrates effects from often unanticipated sources. Thewide range of adverse fetal effects demonstrated among 1.7 million births foundmaternal hospital admission for infection of any source during pregnancy was associated 30 to 40 years later with autism and depression, even with depression that is severe enough to lead to suicide. Significantly more knowledge has to accumulate on the critically important impact of pregnant conditions that influences the newborn's health throughout adulthood. However, the underlying theme is that maternal conditions during pregnancy, particularly those causing inflammation, have long-term effects on the mother, the neonate, and the adult born of that pregnancy. Thus, care givers of pregnant patients have an immense responsibility to insure the best possible maternal pregnancy care and an optimal fetal environment. At present, they use separate realms to identify this wide range of antenatal disease and influences. The first is to insure a healthy fetal genetic and organ structure by the early second trimester of pregnancy. Second is to identify andmodify the effects of hypertension and glucose excesses on both the mother and fetus throughout pregnancy. The third realm is to insure safe mental health, particularly depression and stress on the mother and to identify and monitor alcohol and drug abuse during and after pregnancy. A key fourth realm throughout pregnancy is to properly diagnose and treat infectious diseases, especially STI, a subject the important publication in this journal that outlines the effects of STIs on the mother and fetus. These infections along with urinary tract, respiratory tract, and chorioamnionitis/endometritis infections are important infections that have both immediate maternal and neonatal effects and long-term effects in childhood and adult life, especially if they involve preterm delivery. In optimal circumstances, 13 health care visits occur with approximately 200 hours available for education and care during pregnancy. This visit number is reduced with late prenatal care in developed countries; in developing countries, often only 1 to 4 prenatal visits may occur. During that time, providers