Book Review

Viral Diseases in Pregnancy

N Engl J Med 1994; 331:1595-1596December 8, 1994

Article

Viral Diseases in Pregnancy
(Clinical Perspectives in Obstetrics and Gynecology.) Edited by Bernard Gonik. 267 pp., illustrated. New York, Springer-Verlag, 1994. $79. ISBN: 0-387-94207-6

Viral Diseases in Pregnancy is an excellent book for obstetricians, perinatologists, family practitioners, internists, infectious-disease specialists, and others involved in the care of pregnant women. The unique circumstance of pregnancy forces practitioners to consider the potential influences of viral infection on maternal and fetal health. Many obstetricians find this task daunting; other physicians -- who are, in general, more familiar with viral diseases -- are often unaware of the effect pregnancy has on the natural history of viral diseases. The editor and the 25 outstanding contributing authors all have expertise in different aspects of the overall topic, and the book is a coherent, authoritative, consistent, and up-to-date resource for practitioners providing care for pregnant women.

The book begins with three chapters on general topics related to viral infection: immune responses, teratology, and in utero diagnosis. The first two review basic principles, relate them to pregnancy, and discuss briefly some particularly relevant viral infections. The well-written chapter on in utero diagnosis discusses general clinical features of viral infection and approaches to maternal screening and fetal diagnosis. It reviews various clinical and laboratory diagnostic techniques accurately and clearly. The chapter concludes with descriptions of the current methods of diagnosing specific viral infections during pregnancy.

Each of the next 12 chapters is devoted to one or several viral pathogens, all of which can influence the outcome of pregnancy for the mother, the fetus, or both. Each chapter begins with a description of the virus, its epidemiologic features and pathogenetic properties, and the clinical manifestations of the infection. This is followed by a review of the effects of the virus on pregnancy and on the fetus and the neonate. Finally, diagnostic methods and strategies for prevention and treatment are taken up. Most chapters include clinically relevant tables and figures, and several contain useful algorithms to help guide clinical management. Most have up-to-date bibliographies for readers interested in further study. The consistent organization of the chapters makes this book not only a pleasure to read but also a handy reference source for a variety of clinical situations.

The last chapter, written by the editor, addresses the difficult issue of immunization during pregnancy. Accompanying a concise discussion of the potential risks and benefits of immunization is an extensive table describing various vaccines and listing recommendations for their use during pregnancy. Four pages of color plates depicting the clinical manifestations of viral illness add to the usefulness of the book. The photographs and descriptions of rashes are likely to be particularly helpful when a physician is considering the differential diagnosis in the case of an acutely ill pregnant woman.

This book is the only current work I could find that is completely devoted to viral infections in pregnancy. Viral Diseases of the Fetus and Newborn by James Barry Hanshaw, John Alastair Dudgeon, and William Courtenay (2nd ed. Philadelphia: W.B. Saunders, 1985) addresses a similar subject in an exhaustive manner but is written by and for pediatricians. In contrast, the focus of Viral Diseases in Pregnancy is the care of the pregnant patient. The book will therefore be most useful to providers of prenatal care. For these practitioners, this book will be a valued addition to their libraries.

Judith Pratt Rossiter, M.D.
Johns Hopkins School of Medicine, Baltimore, MD 21287-1228