Infection prevention, medication safety, antimicrobial stewardship, and management of pregnancy complications including mental health and emergency response

Infection, Medications & Complications

Pregnancy care increasingly emphasizes a multifaceted approach that integrates infection prevention, medication safety, antimicrobial stewardship, and the management of pregnancy complications—including mental health and emergency response. Recent evidence and practice updates clarify established protocols while exposing critical gaps, particularly in psychosocial care and emergency preparedness. This synthesis highlights key advances and ongoing challenges in these interconnected domains, reaffirming the central role of vaccination, safe medication use, antimicrobial stewardship, and multidisciplinary management.

Strengthened Evidence and Protocols in Infection Prevention and Medication Safety

Vaccination during pregnancy remains a foundational strategy to protect both mother and neonate from infectious diseases, supported by robust evidence and expanded recommendations:

Maternal Immunizations: RSV, COVID-19, Influenza, Tdap, and Hepatitis B Virus (HBV)
The American College of Obstetricians and Gynecologists (ACOG) and allied bodies continue to endorse routine immunization against influenza, Tdap, COVID-19 (mRNA vaccines), RSV, and HBV. Emerging data affirm the safety and efficacy of maternal RSV vaccination, with interim surveillance showing no increased pregnancy risks and significant reductions in neonatal RSV hospitalizations. Similarly, tailored public health campaigns employing culturally sensitive messaging and community leader engagement have helped overcome vaccine hesitancy in underserved populations.
COVID-19 Vaccination Linked to Reduced Preeclampsia Risk
Beyond infection prevention, recent studies reveal that pregnant individuals receiving COVID-19 vaccines experience a 42% lower risk of developing preeclampsia, a serious hypertensive disorder of pregnancy. This dual protective effect strengthens the rationale for universal prenatal COVID-19 vaccination and supports clear patient counseling to dispel misinformation.
Universal Screening: Group B Streptococcus (GBS) and HBV
The continuation of universal GBS screening at 35–37 weeks’ gestation remains vital to preventing neonatal sepsis. Recent comprehensive reviews in the New England Journal of Medicine reaffirm current intrapartum antibiotic prophylaxis protocols while emphasizing the importance of antimicrobial stewardship to minimize resistance. Likewise, early HBV screening and prophylaxis integrated with neonatal vaccination programs have markedly curtailed vertical transmission rates worldwide.
Medication Safety: Acetaminophen and Aspirin Prophylaxis
A 2026 Lancet meta-analysis exonerates prenatal acetaminophen use from previous concerns regarding neurodevelopmental disorders, reassuring clinicians and patients about its continued role as the preferred analgesic and antipyretic in pregnancy. Concurrently, low-dose aspirin (75–150 mg daily) started before 16 weeks gestation remains a globally endorsed intervention to prevent preeclampsia, with improved patient adherence fostered by shared decision-making tools clarifying risks and benefits.
Antimicrobial Stewardship Initiatives
Hospital-based assessments highlight variability in adherence to antimicrobial prescribing guidelines during pregnancy, prompting initiatives such as provider education, audit and feedback, and integration of stewardship programs within obstetric workflows. Multidisciplinary management of complex infections, including pregnancy-associated infective endocarditis, now routinely involves collaborative teams of obstetricians, infectious disease specialists, and critical care providers, optimizing outcomes while minimizing unnecessary fetal antibiotic exposure.
Expanded Infection Prevention Counseling
Prenatal care increasingly incorporates guidance on environmental and dietary risk factors, including avoidance of Listeria-contaminated foods (e.g., unpasteurized dairy) and endocrine-disrupting chemicals, which are linked to miscarriage and developmental anomalies. Public health campaigns reinforce hand hygiene, safe food handling, and avoidance of raw dairy products. The establishment of the first International Prenatal Infection Prevention Month (February) underscores global commitment to these efforts.

Addressing Mental Health Treatment Gaps and Psychosocial Care

Despite advances in screening and digital supports, mental health treatment adherence during pregnancy remains suboptimal:

Studies document that two-thirds of pregnant individuals prescribed SSRIs discontinue treatment prematurely, often due to safety concerns, stigma, and lack of counseling. This gap fuels calls for universal screening for depression and anxiety at every prenatal visit, coupled with transparent, culturally sensitive risk-benefit discussions.
Digital Mental Health Tools—including mood-tracking apps and psychoeducational platforms—offer scalable adjunctive support, though clinical validation is ongoing. Community-based group prenatal care programs, such as those implemented in Las Vegas, demonstrate significant reductions in postpartum depression by integrating psychotherapy, stress reduction, and patient-informed design.
Behavioral skills training and partner involvement in prenatal classes strengthen psychosocial support networks, enhance maternal well-being, and improve birth satisfaction. Complementary therapies like aromatherapy have also shown promise in reducing labor anxiety and pain perception.
Research highlights severe postpartum stress in approximately one-third of women delivering via cesarean section, emphasizing the need for trauma-informed care and targeted mental health interventions in this population.
Publicly available resources, including practical anxiety management guides and culturally tailored counseling videos (e.g., addressing fears around vaginal delivery and body image), help combat misinformation and empower informed decision-making.

Rising Home Births and Enhanced Emergency Response

The increase in planned home births—notably documented in regions like Lebanon, Ohio—has spotlighted risks of delayed hospital transfers during obstetric emergencies:

To address these challenges, EMS protocols are being updated to include:
- Enhanced EMS training focused on recognition and management of labor, hemorrhage, hypertensive crises, and other obstetric emergencies.
- Streamlined communication pathways linking EMS providers, home birth midwives, and tertiary care centers.
- Deployment of telehealth support during EMS encounters to provide real-time obstetric guidance, improving triage and transfer decisions.
These innovations are particularly critical in maternity care deserts, where geographic and resource limitations impede timely access to hospital-based obstetric care.
Policy initiatives and provider education efforts are underway to ensure that emergency medical systems are equipped to respond effectively to the evolving landscape of childbirth settings.

Precision Diagnostics and Multidisciplinary Management of Complex Pregnancy Complications

Advances in precision medicine and diagnostic technologies are reshaping the management of pregnancy complications:

AI-Enabled Risk Prediction Models synthesize clinical, sociodemographic, and imaging data to identify risks for placenta accreta spectrum (PAS), hypertensive disorders, and fetal growth abnormalities. Built-in bias mitigation mechanisms ensure equitable application across diverse populations.
Metabolomic profiling and serum ferritin assays facilitate early detection of gestational diabetes mellitus (GDM), enabling timely lifestyle or pharmacologic interventions and personalized nutritional counseling.
Multidisciplinary teams coordinate care for complex infections and obstetric complications, integrating obstetricians, infectious disease experts, mental health professionals, and allied health providers to optimize outcomes.
Universal early screening programs and guideline refinements continue to improve detection and management of rare but critical conditions such as gestational trophoblastic disease and placenta previa.

Patient Education and Community Support: Empowering Pregnant Individuals

Comprehensive patient education and community engagement remain pillars of effective pregnancy care:

Initiatives like Minnesota’s Welcome to WIC! program provide early nutrition and breastfeeding support, improving maternal-infant health outcomes.
Updated educational materials clarify distinctions between normal and abnormal pregnancy symptoms, demystify prenatal ultrasound screenings (e.g., 14-week dual marker tests), and provide guidance on culturally sensitive topics such as fasting and exercise.
Community events such as the ‘Womb to World’ mobile clinic enhance access to maternal health resources and foster early engagement.
Digital content addressing common concerns—such as videos on “Why Mostly females Avoid Normal Delivery?”—helps counter misinformation and supports informed birth choices.
Prenatal classes emphasize relaxation techniques, breathing exercises, and partner involvement, enhancing psychosocial resilience and birth experiences.

Conclusion

The evolving landscape of pregnancy care integrates strengthened evidence and protocols for infection prevention and medication safety with a growing recognition of psychosocial and emergency care gaps. The reaffirmation of vaccines—including RSV, COVID-19, influenza, Tdap, and HBV—alongside safe use of acetaminophen and aspirin prophylaxis, underscores a foundation of prevention. Concurrently, antimicrobial stewardship efforts and precision diagnostics enhance the management of complex infections and metabolic disorders.

Addressing mental health treatment gaps and the challenges posed by rising home births demands updated EMS protocols, telehealth integration, and multidisciplinary collaboration. Patient empowerment through tailored education and community-based supports bolsters adherence and well-being.

Together, these advances and initiatives mark a holistic, equitable, and precision-driven approach to maternal and neonatal health—aiming to ensure safer pregnancies and healthier beginnings worldwide.

Selected Resources for Further Reference

Interim data show RSV vaccination safe during pregnancy
COVID shots in pregnancy tied to lower preeclampsia risk in studies
Group B Streptococcal Disease | New England Journal of Medicine
Hospital-Based Assessment of Antimicrobial Prescribing During Pregnancy | IJWH
Surge in Home Births Spotlights Risks of Delayed Hospital Transfers
Maternity Care Deserts: Applying NAEMT and ACOG Guidelines to Real-World EMS Protocols
Perinatal mental health apps: Current evidence and research gaps
Group Therapy, Developed With Help of Patients, Cut Postpartum Depression
Why Mostly females Avoid Normal Delivery? | Does Normal Delivery affects shape? | Dr. Asma Qamar (Video)
Welcome to WIC! - MN Dept. of Health
How to Deal With Anxiety During Pregnancy: Practical Strategies for Emotional Well‑Being