You are here

Article Text

Article menu
Download PDFPDF
Review series
Respiratory diseases in pregnancy • 2
Pneumonia and pregnancy
    1. W S Lima,
    2. J T Macfarlanea,
    3. C L Colthorpeb
    1. aRespiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK, bPharmacy Department, Nottingham City Hospital
    1. Dr J T Macfarlanejohn.macfarlane{at}nottingham.ac.uk

    https://doi.org/10.1136/thorax.56.5.398

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Community acquired pneumonia (CAP) is recognised as a common problem that carries a substantial morbidity and mortality. The burden of disease falls mainly on people at the extremes of age and the occurrence of CAP in young adults is uncommon. Nevertheless, pneumonia in young adults can be severe and fatal.1 In the pregnant patient, pneumonia is the most frequent cause of fatal non-obstetric infection.2

      Concern that pneumonia occurring in a pregnant patient may be more frequent, exhibit atypical features, run a more severe course, or be more difficult to treat than in a non-pregnant patient is not unusual. Underlying these concerns are the recognised physiological and immunological changes that occur during pregnancy which may compromise the mother's ability to respond to an infection. Added to this are concerns for the health of the fetus.

      Changes in pregnancy

      Alterations in cellular immunity have been widely reported and are aimed primarily at protecting the fetus from the mother. These changes include decreased lymphocyte proliferative response, especially in the second and third trimesters, decreased natural killer cell activity, changes in T cell populations with a decrease in numbers of circulating helper T cells, reduced lymphocyte cytotoxic activity, and production by the trophoblast of substances that could block maternal recognition of fetal major histocompatibility antigens.3-7

      In addition, hormones prevalent during pregnancy—including progesterone, human chorionic gonadotropin, alpha-fetoprotein and cortisol—may inhibit cell mediated immune function.6These changes could theoretically increase the risk from infection, particularly by viral and fungal pathogens.

      Anatomically, the enlarging uterus causes elevation of the diaphragm by up to 4 cm and splaying of the thoracic cage. A 2.1 cm increase in the transverse diameter of the chest and a 5–7 cm increase in the circumference of the thoracic cage has been reported.8These changes may decrease the mother's ability to clear secretions. The …

      View Full Text