BACKGROUND Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also associated with significant health care costs. There is evidence that potentially preventable infections may account for up to 15% of early miscarriages and up to 66% of late miscarriages. However, the provision of associated screening and management algorithms is inconsistent for newly pregnant women. Here, we review recent population-based studies on infections that have been shown to be associated with miscarriage. METHODS Our aim was to examine where the current scientific focus lies with regards to the role of infection in miscarriage. Papers dating from June 2009 with key words 'miscarriage' and 'infection' or 'infections' were identified in PubMed (292 and 327 papers, respectively, on 2 June 2014). Relevant human studies (meta-analyses, case-control studies, cohort studies or case series) were included. Single case reports were excluded. The studies were scored based on the Newcastle - Ottawa Quality Assessment Scale. RESULTS The association of systemic infections with malaria, brucellosis, cytomegalovirus and human immunodeficiency virus, dengue fever, influenza virus and of vaginal infection with bacterial vaginosis, with increased risk of miscarriage has been demonstrated. Q fever, adeno-associated virus, Bocavirus, Hepatitis C and Mycoplasma genitalium infections do not appear to affect pregnancy outcome. The effects of Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, Hepatitis B and polyomavirus BK infections remain controversial, as some studies indicate increased miscarriage risk and others show no increased risk. The latest data on rubella and syphilis indicate increased antenatal screening worldwide and a decrease in the frequency of their reported associations with pregnancy failure. Though various pathogens have been associated with miscarriage, the mechanism(s) of infection-induced miscarriage are not yet fully elucidated. CONCLUSIONS Further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.

中文翻译：

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感染在流产中的作用。

背景技术流产是在妊娠的12周（早期流产）或12至24周（晚期流产）之前自然流产。流产发生在五分之一的怀孕中，可能对患者产生相当大的生理和心理影响。它还与大量的医疗费用相关。有证据表明，潜在的可预防的感染可能占早期流产的15％，占晚期流产的66％。然而，对于新孕妇而言，提供相关的筛查和管理算法是不一致的。在这里，我们回顾了最近关于感染与流产有关的基于人群的研究。方法我们的目的是研究感染在流产中的作用方面当前的科学重点。2009年6月在PubMed中发现了关键词为“流产”和“感染”或“感染”的论文（2014年6月2日分别为292和327篇论文）。包括相关的人类研究（元分析，病例对照研究，队列研究或病例系列）。单例报告被排除在外。根据新堡-渥太华质量评估量表对研究进行评分。结果已证明，全身感染与疟疾，布鲁氏菌病，巨细胞病毒和人类免疫缺陷病毒，登革热，流感病毒以及阴道感染伴细菌性阴道病的感染，与流产的风险增加有关。Q热，腺相关病毒，博卡病毒，丙型肝炎和生殖器支原体感染似乎不会影响妊娠结局。沙眼衣原体的影响 弓形虫，人乳头瘤病毒，单纯疱疹病毒，细小病毒B19，乙型肝炎和多瘤病毒BK感染仍然引起争议，因为一些研究表明流产的风险增加，而另一些研究则显示风险没有增加。有关风疹和梅毒的最新数据表明，全世界范围内的产前检查增加，并且其报告的与妊娠失败相关的频率降低。尽管各种病原体与流产有关，但感染引起的流产的机制尚未完全阐明。结论需要进一步的研究来阐明某些感染是否确实增加了流产的风险，以及筛查新孕妇是否可治疗的感染是否会改善生殖结果。乙肝和多瘤病毒BK感染仍然引起争议，因为一些研究表明流产风险增加，而另一些研究则表明风险没有增加。有关风疹和梅毒的最新数据表明，全世界范围内的产前检查增加，并且其报告的与妊娠失败相关的频率降低。尽管各种病原体与流产有关，但感染引起的流产的机制尚未完全阐明。结论需要进一步的研究来阐明某些感染是否确实会增加流产的风险，以及筛查新孕妇是否可治疗的感染是否会改善生殖结果。乙肝和多瘤病毒BK感染仍然存在争议，因为一些研究表明流产风险增加，而另一些研究则表明流产风险没有增加。有关风疹和梅毒的最新数据表明，全世界范围内的产前检查增加，并且其报告的与妊娠失败相关的频率降低。尽管各种病原体与流产有关，但感染引起的流产的机制尚未完全阐明。结论需要进一步的研究来阐明某些感染是否确实增加了流产的风险，以及筛查新孕妇是否可治疗的感染是否会改善生殖结果。有关风疹和梅毒的最新数据表明，全世界范围内的产前检查增加，并且其报告的与妊娠失败相关的频率降低。尽管各种病原体与流产有关，但感染引起的流产的机制尚未完全阐明。结论需要进一步的研究来阐明某些感染是否确实会增加流产的风险，以及筛查新孕妇是否可治疗的感染是否会改善生殖结果。风疹和梅毒的最新数据表明，全世界范围内的产前筛查增加，并且其报告的与妊娠失败相关的频率降低。尽管各种病原体都与流产有关，但感染引起的流产的机制尚未完全阐明。结论需要进一步的研究来阐明某些感染是否确实会增加流产的风险，以及筛查新孕妇是否可治疗的感染是否会改善生殖结果。