Diagnosis of and screening for cytomegalovirus infection in pregnant women

No single diagnostic test for cytomegalovirus (CMV) infection is currently available for pregnant women at all stages of gestation. Improved accuracy in estimating the timing of primary infections can be used to identify women at higher risk of giving birth to congenitally infected infants. A diagnostic algorithm utilizing immunoglobulin G (IgG), IgM, and IgG avidity was used to prospectively screen serum from 600 pregnant women enrolled from two groups: < or =20 weeks gestation (n = 396) or >20 weeks gestation (n = 204). PCR testing of urine and/or blood was performed on all seropositive women (n = 341). The majority (56.8%) of women were CMV IgG seropositive, with 5.5% being also CMV IgM positive. In the IgM-positive women, 1.2% had a low-avidity IgG, indicating a primary CMV infection and a high risk of intrauterine transmission. Two infants with asymptomatic CMV infection were born of mothers who had seroconverted in the second trimester of pregnancy. Baseline, age-stratified CMV serostatus was established from 1,018 blood donors. Baseline seropositivity from a blood donor population increased with age from 34.9% seroprevalence at less than 20 years of age to 72% seroprevalence at 50 years of age. Women at high risk of intrauterine transmission of CMV were identified at all stages of gestation. Women infected with CMV during late gestation may be more likely to transmit the virus, so failure to detect seroconversions in late gestation may result in failure to detect infected neonates.     

Improving diagnosis of primary cytomegalovirus infection in pregnant women using immunoblots

Human cytomegalovirus (CMV) is the most common infectious cause of mental disability in newborns of developed countries. Transmission of CMV from mother to baby is more frequent in maternal primary infection, although CMV reactivation causes more congenital infections overall. Current diagnostic tests for distinguishing primary and reactivation CMV have problems with interpretation and immunoblots may assist with diagnosis. Sera from 60 pregnant women were analyzed using conventional serology in parallel with a commercial immunoblot assay (using Recomblot, Mikrogen Diagnostik). Comparison of detection of CMV IgG, IgM, IgG avidity in maternal primary infection showed the immunoblot relative to conventional serology had sensitivity and specificity of 100% for IgG identification. The detection of IgM on immunoblot showed sensitivity of 75%, specificity of 62.5%, positive predictive value (PPV) of 81.8% and negative predictive value (NPV) of 52.6%. The immunoblot IgG avidity assay had sensitivity of 94.1%, with a PPV of 100% when identifying low avidity serum samples, and sensitivity of 100% with a PPV of 97.1% for high avidity serum samples. Overall agreement between conventional serology (IgM, IgG avidity) and immunoblot (IgM, IgG avidity) for detection of primary CMV infection was 65%. Although the immunoblot is effective in detecting IgG and determining IgG avidity, it showed no significant benefits in performance or utility as a first line diagnostic technique for IgM or primary CMV infection in pregnant women. J. Med. Virol. 85:315–319, 2013. © 2012 Wiley Periodicals, Inc.     

Determinants of measles seroprevalence among pregnant women in Paris,France

Non-immune pregnant women are at risk of severe measles. As the measles vaccination is contraindicated during pregnancy, women should be vaccinated before conception or during the postpartum period. Nevertheless, measles serology is not recommended during pregnancy in France, and there are no data available concerning measles susceptibility and its associated risk factors among pregnant women. The socio-demographic determinants of measles seronegativity have been identified in a prospective cohort of 826 pregnant women in Paris, France. Measles seronegativity was 10.41% (95% CI 8.32–12.50). Women from higher socio-economic groups, born in France after 1980, were more frequently seronegative.     

Awareness and knowledge of mother-to-child transmission of HIV among pregnant women

OBJECTIVE: To evaluate the awareness and knowledge of mother-to-child transmission of HIV and its prevention among pregnant women attending the antenatal clinic of a federal medical center in Nigeria. METHODOLOGY: Valid and reliable questionnaires were interviewer administered to pregnant women at antenatal booking during the study period, prior to being counseled on HIV/AIDS. RESULTS: All respondents were aware of HIV/AIDS. The main sources of information included posters/billboards (37%), radio (36%), television (28%) and health workers (34%). The majority (90%) of the respondents were aware that HIV/AIDS can coexist with pregnancy, but only 68% were aware of mother-to-child transmission. Transplacental route, vaginal delivery and breastfeeding were identified as routes of transmission from mother to child by 65%, 38% and 52% of respondents, respectively. Caesarean section was believed to be a route of transmission by 43% of respondents, but only 3% identified caesarean section as a method of prevention of mother-to-child transmission. CONCLUSION: Though the level of awareness of HIV/AIDS among women attending our antenatal clinic is high, the level of knowledge about mother-to-child transmission is inadequate. There is a need for adequate counseling and education about HIV/AIDS and mother-to-child transmission in antenatal clinics and also through public campaign media.     

HTLV infection among foreign pregnant women living in Spain

Background

The overall seroprevalence of HTLV infection among pregnant women in Spain is below 0.02% and accordingly universal antenatal screening is not recommended. However, as the number of immigrants has significantly increased during the last decade, this population might warrant specific considerations.

Objective

To evaluate the seroprevalence of HTLV infection among immigrant pregnant women living in Spain.

Methods

From January 2009 to December 2010 a cross-sectional study was carried out in all foreign pregnant women attended at 14 Spanish clinics. All were tested for HTLV antibodies using a commercial enzyme-immunoassay, being reactive samples confirmed by Western blot or PCR.

Results

A total of 3337 foreign pregnant women were examined. Their origin was as follows: Latin America 1579 (47%), North Africa 507 (16%), East Europe 606 (18%), Sub-Saharan Africa 316 (9%), North America and West Europe 116 (3.5%) and Asia and Australia 163 (5%). A total of 7 samples were confirmed as HTLV positive, of which 6 were HTLV-1 and 1 HTLV-2. HTLV-1 infection was found in 5 women coming from Latin America and 1 from Morocco. The only woman with HTLV-2 came from Ghana. The overall HTLV seroprevalence was 0.2%, being 0.3% among Latin Americans and 0.2% among Africans. It was absent among women coming from other regions.

Conclusions

The seroprevalence of HTLV infection among foreign pregnant women in Spain is 0.2%, being all cases found in immigrants from Latin America and Africa. Given the benefit of preventing vertical transmission, antenatal screening should be recommended in pregnant women coming from these regions.     

Molecular epidemiology of primary human cytomegalovirus infection in pregnant women and their families

The source of human cytomegalovirus (HCMV) infection was investigated in 29 pregnant women with primary HCMV infection by comparing DNA sequences of UL146, UL144 and a portion of UL55 gene of HCMV strains circulating within each family. Thirteen families were identified in which the pregnant woman, the husband and/or a child were shedding HCMV. In three of these families, both the woman and the husband suffered from a concomitant primary HCMV infection. Phylogenetic analysis of UL146, UL144, and UL55 genes indicated that strains circulating within each family were identical, whereas strains from different families appeared to be distinct. However, identical UL146, UL144, and UL55 DNA sequences were observed sporadically among unrelated strains. A child rather than the husband was the virus source for the great majority of pregnant women. No association was observed between UL144 polymorphisms and intrauterine transmission.     

Low cytomegalovirus sero-prevalence in Irish pregnant women

The aim of this study was to determine the sero-prevalence of cytomegalovirus (CMV) IgG antibody in pregnant women in Ireland and assess individual risk factors for prior acquisition of CMV. In 2002, sera from 1047 pregnant women were tested by enzyme immunoassay for CMV IgG. Age and nationality were recorded for each patient. Among Irish-born women the following additional factors were also recorded: socio-economic status, number of children and occupational exposure to children. Only 30.4% (204/670) of Irish women were CMV antibody positive compared to 89.7% (322/359) of non-Irish women (p < 0.001). Non-Irish women were mostly from Sub-Saharan Africa, Eastern Europe and Asia. Lower socio-economic group and increasing number of children were significant independent predictors of CMV sero-positivity among Irish pregnant women (p < 0.05). Irish pregnant women have one of the lowest reported CMV sero-prevalence rates worldwide, indicating low circulation of CMV within the community. However, up to 70% of Irish women are susceptible to a primary infection during pregnancy.     

温州市区育龄妇女孕前巨细胞病毒感染现状调查

目的了解温州地区育龄妇女孕前人巨细胞病毒（HCMV）感染的状况。方法收集2008年10月至2010年6日参加温州市龙湾区免费孕前优生筛查的妇女血标本2869份,采用酶联免疫吸附试验（ELISA）检测血清HCMV IgG/IgM抗体;HCMV IgM抗体阳性标本,采用实时荧光定量聚合酶链反应（FQ-PCR）检测血HCMV DNA载量;HCMV IgG/IgM抗体双阳性标本,采用尿素变性结合ELISA技术检测IgG抗体亲和力指数（AI）。结果 2869份孕前妇女血清中HC-MV IgG抗体阳性检出率为97.77%（2805/2869）,HCMV IgM抗体阳性检出率为0.77%（22/2 869）,IgG/IgM抗体均阳性检出率占0.17%（5/2 869）;22份HCMV IgM阳性标本中,血HCMV DNA阳性检出率为68.18%（15/22）;5份HCMVIgG/IgM双阳性标本中,检出低亲和力IgG抗体1份,中等亲和力IgG抗体2份,高亲和力IgG抗体2份。结论温州市区育龄妇女孕前HCMV IgG抗体阳性率高;对HCMV IgM抗体阳性孕前妇女应进行多指标检测以判断HCMV感染的状态,为减少出生缺陷、做好优生优育服务提供依据。     

Seroprevalence of cytomegalovirus among pregnant women attending Murtala Mohammed Specialist Hospital Kano,Nigeria

Background

Primary Cytomegalovirus (CMV) infection during pregnancy is a frequent and serious threat to the fetus. As there is no vaccine alternative measures are needed to prevent congenital CMV infection.

Objective

This study determined CMV Immunoglobulin G (IgG) antibody among pregnant women in order to ascertain the immune status of mothers to guide policy makers.

Methods

A semi-structured questionnaire was initially administered to obtain information on demographic details, stage of pregnancy and risk factors. Blood was collected by venipuncture from 180 women attending the antenatal clinic in Murtala Mohammed Specialist Hospital Kano, Kano State, Nigeria. Sera samples were screened using CMV IgG ELISA kit (Dialab, Austria).

Results

Out of 180 pregnant women, 164 (91.1%) were seropositive. Based on stages of pregnancy 6/6(100%), 52/60(86.7%) and 106/114(93.0%) were seropositive among women in the first, second and third trimesters respectively.

Conclusion

Seroprevalence of pregnant women to CMV Ig G is high, hence the need for CMV - IgM screening to know the extent of active infection. There is also need for public enlightenment on the methods of transmission, effective prevention and control strategies.     

Use of serial maternal urine cytomegalovirus PCR to detect primary CMV infection in seronegative pregnant women

The aim of the study was to determine if serial maternal urine polymerase chain reaction (PCR) tests can detect primary CMV infection during pregnancy. This was a prospective study conducted from 1 January 1999 to 31 December 1999 in an antenatal clinic setting of a teaching hospital. The study group included women who were CMV IgG negative and aged <30 years or had a pre-school child. They were invited to self-collect urine samples monthly and send them to the laboratory by post. Cord bloods were tested for CMV IgG to detect seroconversion. An anxiety questionnaire was sent to all study participants. At first attendance, 1549 (42%) women were CMV IgG negative. Of the 696 eligible women, 609 (88%) participated in the urine PCR study. PCR was performed on 2263 urine samples (median of 4/pregnancy). Primary CMV infection was identified in one woman by urine PCR at 36 weeks (baby CMV negative). Cord blood samples were available from 152/609 infants (25%). Seroconversion was noted in only one woman. Replies to the questionnaire were received from 264/609 women (43%): 214 (81%) had little or no anxiety, and 220 (83%) felt reassured by their study participation. Serial urine PCR is a feasible method of detecting primary maternal CMV infection during pregnancy which has potential for evaluation in further studies.     

Helicobacter pylori seroprevalence in asymptomatic pregnant women in France

The purpose of our study was to evaluate the incidence of Helicobacter pylori seropositivity in two different populations of asymptomatic pregnant women from different geographic origins during two separate time periods. A retrospective study of consecutive sera obtained from 169 and 302 asymptomatic pregnant women in 1990 and 1999, respectively, was carried out. The global H. pylori seroprevalences for 1990 and 1999 were 21.3 and 21.5% (where P is nonsignificant), respectively. For both periods the H. pylori seroprevalences were significantly higher in non-French pregnant women (66.6 and 50.6%) than in French pregnant women (18.7 and 11.2%) (P = 0.01 and 0.001, respectively). H. pylori seroprevalence in French pregnant women decreased significantly from the first period (18.7%) to the second one (11.2%) (P = 0.03).     

孕妇血清中人类巨细胞病毒DNA含量与胎儿宫内感染的关系

目的探讨孕妇血清中人类巨细胞病毒DNA(HCMV DNA)含量与胎儿宫内感染发生率的关系.方法用PCR方法结合荧光探针的体外扩增和检测技术,检测186例HCMV感染孕妇及胎儿或新生儿血清、胚胎、绒毛中HCMVDNA拷贝数.结果胎儿发生宫内感染及妊娠不良结局与其母素血清HCMV DNA含量有关,随着孕妇血清中HCMV DNA含量的增高,胎儿宫内感染及不良妊娠结局的危险性也呈显著增高趋势.结论孕妇血清HCMV DNA含量升高是胎儿感染HCMV并发生妊娠不良结局的重要因素之一.     

Low prevalence of hepatitis E infection among pregnant women in Madrid,Spain

Hepatitis E virus, a cause of sporadic hepatitis in developed countries is present in Spain. The aims of this study were to determine whether the prevalence of IgG anti‐hepatitis E virus antibodies has increased in recent years in Spain and the prevalence in a study population at risk of developing the disease following the infection. Serum samples from 1,040 women in the first trimester of pregnancy were studied. The prevalence rate of 3.6% has not increased significantly since 1999 in spite of the large number of immigrants from endemic regions. IgM anti‐HEV antibodies were detected in 0.67% of the patients suggesting that although subclinical infection exists the prevalence is very low. The reasons for the differences in the morbidity of HEV in pregnant women in different geographical areas remain unclear. Good hygienic measures and public health conditions are important factors for ensuring low prevalence of hepatitis E in Spain. J. Med. Virol. 82:1666–1668, 2010. 2010 Wiley‐Liss, Inc.     

Knowledge on hepatitis B infection among pregnant women in a high endemicity area

Objective

To assess the knowledge on hepatitis B virus (HBV) infection and associated factors among expectant mothers in an endemic region.

Methods

A questionnaire was administered to pregnant Chinese women (n = 1623) attending the antenatal clinic to examine their knowledge on HBV infection, and correlating this with socio-demographic, medical and obstetric factors.

Results

Independent factors associated with insufficient reduced HBV knowledge include women outside the healthcare sector, lower education level, and no previous HBV testing. The majority of respondents could provide correct responses about the common aspects of HBV infection, including screening, blood-borne and perinatal transmissions, prevention by vaccination, and sequelae of HBV infection, but 47.1% did not know that HBV is transmissible by sexual intercourse. Over 75% respondents misunderstood the fact that HBV cannot be transmitted through food, or prevented by a balanced life style and nutrition.

Conclusions

Misconceptions about HBV transmission are still common among the obstetric population, and the provision of appropriate and correct information is warranted to improve further the control of HBV infection to the target group.

Practice implications

Appropriate emphasis should be given to educating the general population about horizontal transmission of HBV.     

Hepatitis B virus infection among pregnant women in Haiti: A cross-sectional serosurvey

BackgroundHepatitis B vaccine administered shortly after birth is highly effective in preventing mother to child transmission (MTCT) of infection. While hepatitis B vaccine was introduced in Haiti as part of a combined pentavalent vaccine in 2012, a birth dose is not yet included in the immunization schedule.ObjectivesDetermine the seroprevalence of hepatitis B virus (HBV) infection among pregnant women to evaluate the risk of MTCT.Study designWe selected 1364 residual serum specimens collected during a 2012 human immunodeficiency virus (HIV) sentinel serosurvey among pregnant women attending antenatal care clinics. Haiti was stratified into two regions: West, which includes metropolitan Port-au-Prince, and non-West, which includes all other departments. We evaluated the association between demographic and socioeconomic characteristics and HIV infection with HBV infection.ResultsOf 1364 selected specimens, 1307 (96%) were available for testing. A total of 422 specimens (32.7%) tested positive for total anti-HBc (38.2% in West vs. 27% in non-West, p < 0.001), and 33 specimens (2.5%) were HBsAg positive (2.1% in West vs. 3% in non-West, p = 0.4). Of HBsAg positive specimens, 79% had detectable HBV DNA. Women aged 30 and older had more than double the odds of positive total anti-HBc than women aged 15–19 years (p < 0.001). Women with secondary (adjusted odds ratio (aOR) = 0.54; 95% CI: 0.36–0.81) and post-secondary education (aOR = 0.40, 95% CI: 0.19–0.79) had lower odds of total anti-HBc positivity compared with women with no education. HIV-status was not associated with HBV infection.ConclusionsHaiti has an intermediate endemicity of chronic HBV infection with high prevalence of positive HBV DNA among chronically infected women. Introduction of a universal birth dose of hepatitis B vaccine might help prevent perinatal HBV transmission.     

Human T-cell lymphotropic virus type 1 infection among pregnant women in northeastern Brazil

An evaluation of human T-cell lymphotropic virus type 1 (HTLV-1) infection among 6754 pregnant women in Salvador, Bahia, Brazil using enzyme-linked immunosorbent assay, Western blot analysis, and polymerase chain reaction assay found a rate of infection of 0.84% (57 of 6754 women). Epidemiologic and obstetric data on the HTLV-1-positive pregnant women were analyzed and compared with data on a control group of HTLV-1-negative pregnant women. The mean age of the HTLV-1-positive women was 26.2 years. All were seronegative for HIV and syphilis, and only 2 reported a past history of sexually transmitted infection and more than 10 sexual partners. Of the HTLV-1-positive women, 88.5% were breast-fed, 4% were bottle fed, and 7.5% did not know. Six women had received blood transfusions, and only 1 reported intravenous drug use. Fifty-two HTLV-1-positive women could be followed: 45 had full-term deliveries, 5 had premature deliveries, and 2 had abortions. Our results indicate that (1) the frequency of HTLV-1 infection among pregnant women is relatively high in Salvador, Bahia, Brazil; (2) maternal infection was probably acquired more frequently through breast-feeding, but the sexual route was certainly the second most important means of transmission; (3) HTLV-1-positive women had a history of eczema-like infections in childhood more frequently than the control group; (4) HTLV-1 infection did not interfere in the course of pregnancy; and (5) no associated congenital infections were observed in the HTLV-1-positive women.     

Neutralizing antibody response to cytomegalovirus in seropositive pregnant women.

The neutralizing (NT) antibody response to human cytomegalovirus (HCMV) in seropositive pregnant women was evaluated to establish the role of protective humoral immunity in HCMV infections (reactivation) during pregnancy. Complement fixation (CF) antibody titers increased significantly in 54 (0.62%) of 8,663 seropositive cases tested during gestation. However, titers of NT antibody, when tested in the presence of complement (C'), increased as gestation progressed and exceeded 1:500 in most of the cases in whom the CF antibody titer had shown earlier an insignificant increase. When NT antibodies were tested in the absence of C', insignificant increase in titers were found. The results suggest that the presence of high titer of NT antibody may play an important role in protective humoral immunity against reactivation of HCMV in pregnant women, and may also be effective in preventing intrauterine infection and modulating the severity of perinatal infection in offspring borne of HCMV carrier mothers.     

Seroprevalence of Toxoplasma gondii infection among immigrant and native pregnant women in Eastern Spain

In European countries, toxoplasma antenatal screening is recommended to prevent toxoplasmosis. The seroprevalence of these infections in immigrants can be different than in native population. From February 2006 to June 2010, a cross-sectional study was carried out in all pregnant women attended at a reference unit in Elche, Spain. An enzyme immunoassay was used for detection of IgG antibodies against Toxoplasma gondii. For each immigrant woman, one Spanish pregnant woman of the same age cared for in the same day was recruited (Spanish control group). A total of 1,627 migrant pregnant women participated in this study. The adherence to screening among migrants was 91.9% (95% CI, 90.5–93.1%), similar than that found in Spaniards (92.2%; 95% CI, 90.8–93-4%). Among migrant women, 619 were positive for IgG anti-T. gondii antibodies (41.4%; 95% CI, 38.9–43.9%), compared with 12.0% (95% CI, 10.5–13.8%) among Spaniards (odds ratio (OR), 5.2 (95% CI, 4.3–6.3). Seroprevalence in pregnant women from Latin America, northern Africa, Eastern Europe, Africa Sub-Saharan and Western Europe was higher than in the Spanish control group (OR, 5.4, 5.8, 6.5, 5.4, and 2.4, respectively; p < 0.001). No Asian pregnant woman was immune. Seroprevalence increased with increasing age in migrant pregnant women: 15–25 years, 38.2%; 26–35 years, 40.7%; and 36–45 years, 52.8%. The seroprevalence of T. gondii infection in migrant pregnant women living in Spain was higher than in the native population. However, no cases were found in Asian immigrants, highlighting the importance of primary prevention of this infection in pregnant women coming from that geographic region.