Subclinical or leukemia
they have occurred around the time of parturition, the baby is not protected by maternal antibody. The various congenital syndromes may be difficult to distinguish without recourse to virus isolation and IgM serology. Unequivocal laboratory confirmation is important, first because progressive damage can occur after birth and some viruses may be amenable to chemotherapy, and second because appropriate medical, social, and educational measures should be initiated as early as possible.
Still other viruses are commonly acquired within the first few weeks of life (postnatal infections) Newborn babies of hepatitis B virus carrier mothers almost always themselves become lifelong HBsAg carriers within the first few months of life; possible routes of infection were discussed in Chapter 22. The probability of perinatal transmission of hepatitis C from a carrier mother to her infant is much lower. However, the risk of transmission of the human immunodeficiency virus from an HIV-positive mother to her newborn baby is substantial. Again the route of postnatal (or natal) transmission is not known for sure but was discussed in Chapter 35. A similar situation obtains with HTLV-1 and HTLV-2.
At risk of stretching Ihe definition of postnatal infection, we should for completeness remind the reader that the herpesviruses cytomegalovirus, Epstein-Barr virus, and HSV-1 tend to be acquired "vertically" from the mother via saliva (CMV, EBV, HSV-1) or milk (CMV) very early in life, particularly in the Third World, whereas others such as rotavirus and respiratory syncytial virus may be picked up by "horizontal" transmission, even by nosocomial spread in hospital nurseries, fn genera], such infections acquired from the mother shortly after birth are subclinical, having been acquired under the "umbrella" of maternal antibodies. However, there are two main circumstances under which such transmission is fraught with danger: (1) when the mother has experienced her primary infection so recently thai the baby is not protected by antibody or (2) when the baby suffers from some form of congenital immunodeficiency or is significantly premature or sickly.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.