New advances in the diagnosis of congenital cytomegalovirus infection

With the advances in anticytomegalovirus (anti-CMV) serology, the new recombinant IgM tests seem likely to become the screening tests for pregnant women whose prepregnancy serological status for CMV is unknown. When a woman is found to be IgM-positive, further diagnostic evaluation focused on determining whether this is due to a primary infection should be carried out. Maternal primary infections that were difficult to determine until a few years ago unless documented by seroconversion can now be readily diagnosed from the presence of low-avidity anti-CMV antibody which persists for approximately 20 weeks after primary infection. In primarily infected mothers prenatal diagnosis can be performed between 21 and 23 weeks of gestation, and the amniotic fluid (AF) represents the pathological material of choice to determine intrauterine virus transmission. In AF, the virus can be detected by culture and/or PCR. Both procedures differentiate uninfected from infected fetuses, but cannot predict fetal outcome. The determination of the viral load in AF carried out by quantitative PCR is more promising and could represent an important starting point for preemptive fetal therapy.     

孕产妇四种病原体感染血清学筛查的研究

目的 探讨正常孕妇弓形虫、风疹病毒、巨细胞病毒、单纯疱疹病毒(Torch)感染血清学筛查的意义，妊娠伴胚胎停止发育及产史不良与Torch感染的关系。方法 间接荧光法检测血清Torch—IgG抗体和酶免疫捕获法检测Torch—IgM抗体。303例孕妇、27例妊娠伴胚胎停育及192例产史不良妇女进行了弓形虫血清学筛查，进行风疹病毒血清学筛查的分别278，30和214例，巨细胞病毒(CMV)筛查的分别为280，31和228例，单纯疱疹病毒(HSV)筛查的分别为236，25和168例。结果 孕妇、妊娠伴胚胎停育和产史不良妇女血清弓形虫IgG／IgM抗体阳性率分别为2．3％／0．33％，0／0，1．04％／0；风疹病毒IgG／IgM抗体阳性率分别为93．2％／1．4％，96．7％／0，98．6％／0；CMV—IgG／IgM阳性率分别为88．6％／1．1％，87．1％／0，91．2％／0；HSV—IgG／IgM阳性率分别为93．2％/1.3％，88．0％／0，94．6％/0。外院Torch—IgM抗体阳性的31份孕妇血清标本仅确认1份为真正阳性。结论 孕妇弓形虫感染率低，常规筛查的价值需要探讨。妊娠前确定风疹的免疫状态对孕妇风疹筛查意义重大。孕妇CMV血清学筛查方案需要进一步研究。初筛Torch—IgM抗体阳性的血清标本应当复查和确认，以避免假阳性。未发现妊娠伴胚胎停止发育以及产史不良与Torch感染存在关联。     

孝感市单中心高危新生儿先天性巨细胞病毒感染率及高病毒载量危险因素分析

目的 调查孝感地区高危新生儿中先天性巨细胞病毒(cytomegalovirus, CMV)感染状况并分析其高病毒载量的危险因素。方法 选取2018年1月至2020年12月武汉科技大学附属孝感医院新生儿科收治的高危新生儿作为研究对象,留取尿液标本行CMV-DNA定量聚合酶链式反应(polymerase chain reaction,PCR)检测,计算感染率。根据定量PCR检测病毒DNA载量分为高载量组和低载量组,比较两组临床资料,采用多因素Logistic回归分析筛查高危新生儿中先天性CMV感染高病毒DNA载量的独立危险因素。结果 武汉科技大学附属孝感医院收治的高危新生儿中,先天性CMV感染率约为7.0%(172/2 448)。两组在孕妇居住地、羊水有无异常方面差异有统计学意义(均P<0.05)。多因素Logistic回归分析提示,孕妇居住在农村、羊水异常增加了高危新生儿先天性CMV感染后高病毒DNA载量的风险(均P<0.05)。结论 孝感地区高危新生儿中先天性CMV感染率相对较高,应加强区域孕期保健管理及分娩后CMV筛查,尤其是农村孕妇,羊水异常者。     

Cytomegalovirus infection in pregnancy: a still complicated diagnostic problem

The diagnostic problems linked to human cytomegalovirus (HCMV) in pregnancy are many and not all have been fully defined. In long-term seropositive women there is a tacit agreement that no laboratory testing for HCMV should be carried out. In seronegative women a test for HCMV-specific IgG should be performed at least twice during the first 4 months of pregnancy, and if the seronegativity persists, further follow-up might be stopped. On the other hand, if a seropositivity appears the diagnosis of a primary HCMV infection is established and prenatal diagnosis should be offered to the mother. Finally, in the case of a pregnant woman with unknown serological status, the diagnosis of HCMV infection is a complex problem and several different questions need to be addressed. In our opinion they should be screened with a reliable IgM test (confirmed by blot if necessary) followed, in the case of positivity, by an avidity assay. Pregnant women undergoing a primary HCMV infection should be encouraged to seek prenatal diagnosis to be performed by PCR and virus isolation from amniotic fluid at the 21st to 23rd week of gestation.     

2862例孕妇TORCH感染情况调查分析

目的了解广东地区孕妇感染弓形虫（TOX）、风疹病毒（RV）、巨细胞病毒（CMV）、疱疹病毒（HSV）的现状。方法采用抗体捕获酶联免疫吸附试验（EIJISA）法对2006年1月至2008年11月进行产前检查的2862例孕妇进行TOX、RV、CMV、HSV-Ⅰ、HSV-Ⅱ检测。结果妊娠妇女检测TORCH-Ⅱ HSV-Ⅱ／的阳性率分别为0．62％、2．8％、12．5％、3．2％和7．8％。结论广东地区妊娠妇女巨细胞病毒感染较高,应及早对育龄妇女进行更广泛的TORCH筛查,做好优生优育工作,提高人口出生素质。     

Clinical factor associated with congenital cytomegalovirus infection in pregnant women with non-primary infection

The aim of this nested case-control study was to evaluate clinical factors associated with the occurrence of congenital cytomegalovirus (CMV) infection in pregnant women with non-primary CMV infection. In a cohort study of CMV screening for 2193 pregnant women and their newborns, seven newborns with congenital CMV infection were identified among 1287 pregnant women with non-primary CMV infection that was defined as negative IgM and positive IgG with IgG avidity index >45%. In the 1287 women with non-primary CMV infection, clinical findings and complications were compared between pregnancies with and without congenital CMV infection. Clinical factors associated with the occurrence of congenital CMV infection were evaluated. The birth weight of newborns with congenital CMV infection was less than that of newborns without congenital infection (p < 0.05). Univariate logistic regression analyses demonstrated that threatened premature delivery (OR 10.6, 95%CI 2.0–55.0; p < 0.01) and multiple pregnancy (OR 7.1, 95%CI 1.4–37.4; p < 0.05) were associated with congenital infection. Multivariable logistic regression analyses demonstrated that threatened premature delivery (OR 8.4, 95%CI 1.5–48.1; p < 0.05) was a single risk factor for congenital CMV infection in pregnant women with non-primary CMV infection. This study revealed for the first time that threatened premature delivery was associated with the occurrence of congenital CMV infection in pregnant women with non-primary CMV infection, the pathophysiology of which may be closely associated with CMV reactivation during pregnancy.     

Kinetics of CMV seroconversion in a Swiss pregnant women population

Retrospective evaluation of the kinetics of cytomegalovirus (CMV) seroconversion with CMV IgM, IgG, and IgG avidity assays, in a Swiss pregnant women population, has shown that the current published CMV serologic diagnostic algorithms were valid and fit for use. In 19% of the cases analyzed, CMV-specific IgM was detected before IgG.     

Seroprevalence of CMV IgG and IgM in Korean women of childbearing age

BackgroundThe aim of this study was to investigate the seroprevalence of cytomegalovirus (CMV) infection using the serologic status of CMV IgG and IgM antibodies in Korean women of childbearing age.MethodsWe retrospectively reviewed CMV IgG and IgM test results from Korean women aged 15–49 years who underwent testing between January 2009 and December 2019. Seroprevalence of CMV IgG and IgM by year and age was investigated.ResultsThe study period was 11 years, and among 6837 samples tested, 95.8% were CMV IgG–positive. The seropositivity in women aged 15‐ <20 years was significantly lower (77.5%) than older age groups. Among 6837 total CMV IgG tests, 75.9% (5186) had concurrently measured CMV IgM results among which 2.4% were IgM‐positive.ConclusionConsidering the low CMV seropositivity of women younger than 20 years, they may need prenatal education for CMV infection.     

Combination of line immunoassays Mikrogen recomLine CMV IgG and recomLine CMV IgG Avidity helps to date the onset of CMV primary infection

CMV IgG avidity assays are widely used and can be helpful in pregnant women to date the onset of CMV primary infection; however, these tests are not standardized and sometimes give inconclusive results. We evaluated the performances of Mikrogen recomLine CMV IgG and IgG Avidity compared to the VIDAS CMV IgG Avidity. On a first sample set of 89 sequential sera collected from 40 women with precisely determined onset of CMV primary infection, the combination of Mikrogen recomLine CMV IgG and IgG Avidity showed an accurate interpretation in 83.1% (74/89), an incorrect result in 4.5% (4/89), and an inconclusive result in 12.4% (11/89) and showed a better sensitivity to diagnose infections <14?weeks compared to VIDAS (85.9% vs. 76.9%). On a second sample set of 89 sera with an intermediate VIDAS CMV IgG Avidity, the combination of line immunoassays provided additional information on the time of infection in 79% (70/89) of the samples. This combination of line assays is useful as additional confirmatory testing and can help to date more precisely the onset of CMV primary infection.     

铜陵地区2845例孕妇TORCH感染状况分析

目的了解铜陵地区孕妇TORCH感染状况,分析其与妊娠年龄的关系。方法对2010年1月至2012年11月进行孕检的2 845例孕妇抽取血样,用酶联免疫吸附法对TORCH-IgM抗体进行检测。结果孕妇TORCH-IgM总阳性率2.601%,弓形虫(TOX),风疹病毒(RV),巨细胞病毒(CMV)和单纯疱疹病毒(HSVⅡ)IgM抗体阳性率分别为0.141%,0.211%,1.617%,0.738%;其中高龄(35～50岁)孕妇组TORCH-IgM总阳性率和CMV-IgM阳性率(6.178%,5.405%)均明显高于适龄(20～34岁)组(2.243%,1.237%)(P<0.01)。结论铜陵地区孕妇TORCH-IgM阳性率较低,高龄是孕妇发生CMV感染的一个高危因素,应加强孕妇的产前筛查,提高人口质量。     

Syphilis in pregnancy

The course and outcome of 356 pregnant patients who had a positive serologic test for syphilis and who had delivery at the LSU Medical Center between Jan 1, 1982 and Dec 31, 1984 were compared to those of our general obstetric population. Records of these women and their infants were reviewed for details of prenatal care, diagnosis of syphilis, past treatment, discharge diagnoses, and follow-up. Syphilis occurred during the index pregnancy in 159 cases. Women with syphilis were older, likely to be black and unmarried, and likely to have been pregnant before. Their prenatal care was the same as that of our general obstetric population. Prematurity in syphilitic pregnancies was twice that of our general population; stillborns were four times as common. Eighty-six patients were treated before delivery and 73 were not; the latter included women without prenatal care, those who contracted syphilis after negative early pregnancy screening, and those not treated because of physician error. Forty-nine infants had probable congenital syphilis; seven were stillborn and 42 liveborn.     

A cohort study of maternal screening for congenital Toxoplasma gondii infection: 12 years' experience

Primary infection with Toxoplasma gondii (T. gondii) during pregnancy may cause congenital infection of the infant. This study evaluated whether screening using IgG avidity and multiplex-nested polymerase chain reaction (PCR) methods was effective for detecting a high-risk pregnancy for congenital T. gondii infection. In a prospective cohort study serum T. gondii IgG avidity was measured in 469 pregnant women who had a positive test for T. gondii antibody plus a positive or equivocal test for IgM. Multiplex-nested PCR for T. gondii DNA on amniotic fluid, maternal blood, and neonatal blood was performed with informed consent. Low (<30%), borderline (30–35%), and high (>35%) IgG avidity indices were found in 104 (22.2%), 30 (6.4%), and 305 (71.4%), respectively. A total of 12 cases had a positive PCR test for amniotic fluids of the prenatal amniocentesis or at birth, or neonatal blood. Seven of the 12 cases were diagnosed as having congenital T. gondii infection, and they had low IgG avidity indices. Congenital T. gondii infection screening using of IgG avidity and multiplex-nested PCR methods for pregnant women with a positive test for T. gondii antibody plus a positive or equivocal test for T. gondii IgM was useful for detecting a high-risk pregnancy and diagnosing congenital T. gondii infection.     

Prenatal diagnosis of cytomegalovirus infection

Prognostic value of markers of cytomegalovirus infection (CMV) in pregnant women for the neonatal status was assessed. Detection of such markers as antiCMV IgM and CMV DNA in cervical secretion by DNA dot-spot hybridization in women with a complicated course of pregnancy indicates a 5.7% risk of delivery of children with stable symptoms. Studies of antibodies to pre-early proteins (IE CMV) showed that antiCMV IgG to IE are more incident in pregnant women than antiCMV IgM; moreover, antiCMV IgG to IE but not antiCMV IgM are detected in umbilical blood. The results of detection of antiCMV IgG and IgM to IE correlated with the clinical characteristics of newborns.     

早孕期唐氏综合征产前筛查结果的回顾性分析

目的:分析并评价早孕期唐氏综合征筛查系统在我院开展情况,为提高实验室产前筛查质量及产前筛查诊断准确率提供指导依据.方法:选择2017年1月~2019年3月在我院产科门诊接受早孕期唐氏综合征筛查的7547例单胎妊娠孕妇作为研究对象,在对孕妇进行充分知情告知后进行超声NT检测,同时抽取孕妇外周血,检测相生化关标记物,使用风险评估软件评估胎儿罹患21-三体、18-三体综合征的概率.对筛查结果高风险的孕妇即刻进行电话召回进行产前诊断.结果:在7547例接受早孕期唐氏综合征筛查的孕妇中,筛查结果高风险共计121例(阳性率1.60%),自愿接受羊水或脐血穿刺产前诊断检查70例,发现染色体核型异常6例;未接受产前诊断检查的51例孕妇中发现其他异常4例.结论:早孕期唐氏综合征筛查有利于早期诊断胎儿染色体异常,可使产前诊断时机推前,对防止出生缺陷,提高人口素质具有重要临床意义.     

Screening and treatment for sexually transmitted infections in pregnancy

Many sexually transmitted infections are associated with adverse pregnancy outcomes. The Centers for Disease Control and Prevention recommends screening all pregnant women for human immunodeficiency virus infection as early as possible. Treatment with highly active antiretroviral therapy can reduce transmission to the fetus. Chlamydia screening is recommended for all women at the onset of prenatal care, and again in the third trimester for women who are younger than 25 years or at increased risk. Azithromycin has been shown to be safe in pregnant women and is recommended as the treatment of choice for chlamydia during pregnancy. Screening for gonorrhea is recommended in early pregnancy for those who are at risk or who live in a high-prevalence area, and again in the third trimester for patients who continue to be at risk. The recommended treatment for gonorrhea is ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally. Hepatitis B surface antigen and serology for syphilis should be checked at the first prenatal visit. Benzathine penicillin G remains the treatment for syphilis. Screening for genital herpes simplex virus infection is by history and examination for lesions, with diagnosis of new cases by culture or polymerase chain reaction assay from active lesions. Routine serology is not recommended for screening. The oral antivirals acyclovir and valacyclovir can be used in pregnancy. Suppressive therapy from 36 weeks' gestation reduces viral shedding at the time of delivery in patients at risk of active lesions. Screening for trichomoniasis or bacterial vaginosis is not recommended for asymptomatic women because current evidence indicates that treatment does not improve pregnancy outcomes.     

唐氏筛查在孕妇产前诊断中的必要性研究

目的探讨唐氏筛查在孕妇产前诊断中的重要意义.方法于妊娠中期利用孕妇血清中甲胎蛋白(AFP)、人绒毛膜促性腺激素(HCG)、游离雌三醇(UE3)三联标记物进行产前筛查胎儿唐氏综合征,唐氏高风险人群经羊膜腔穿刺术,进行荧光原位杂交技术和羊水培养染色体核型分析进行确诊.结果共筛查3654例孕妇,其中超过35岁者192例,占筛查总数的5.2%.初筛出DS高危孕妇103例,筛查阳性率为2.81%,接受羊水产前诊断的胎儿染色体异常3例,占2.91%;而没有接受唐氏筛查的383例孕妇中,出现1例唐氏综合征患儿,两组比较,差异有统计学意义(P<0.05).结论通过血清学的筛查提高了孕妇产前诊断的异常检出率,说明该筛查系统在判断异常妊娠结局方面有重要参考价值.     

产前筛查高风险孕妇心理状况调查及相关因素分析

目的 探讨产前筛查高风险孕妇焦虑程度与相关因素的关系.方法 通过Zung氏焦虑自评量表(SAS)和孕妇一般资料问卷对150例产前筛查高风险孕妇进行心理焦虑程度测评.结果 不同年龄、职业、经济收入、不同文化程度及不同的孕产次的产前筛查高风险孕妇焦虑程度不同;30 ～40岁妇女、无职业、月收入在2 000元以下、中专及以下学历、孕2次产次为1的产前筛查高风险孕妇焦虑程度较重.结论 Zung氏焦虑自评量表(SAS)和孕妇一般资料问卷能够发现不同社会群体的产前筛查高风险孕妇具有不同心理焦虑状态及其特征,为协调完善产前筛查伦理问题及临床制定医疗方案做基础,为产前诊断中心制定相关政策作参考.     

Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy

The role of the sexual transmission of human cytomegalovirus (CMV) as a cause of congenital infection was investigated. Serum samples were collected from 756 pregnant women at 10 to 12 weeks of gestation and at 32 to 36 weeks of gestation. Serum samples were also obtained from the husbands of women who seroconverted and women who were seronegative during pregnancy. Commercially available enzyme immunoassay kits were used to detect serum IgG, IgM, and IgA antibodies against CMV. CMV from neonatal urinary specimens was isolated according to a standard tissue culture technique, using MRC-5 cells. At 10 to 12 weeks of gestation, 634 of the 756 pregnant women (83.9%) had IgG antibody to CMV. At 32 to 36 weeks of gestation, 642 of the 756 women (84.9%) had IgG antibody to CMV. A meaningful rise of serum IgG-antibody titer (seroconversion) occurred in 8 women (1.1%). CMV was isolated from the urine of an infant born to a seroconverted woman within a week after birth. The prevalence of IgG antibody to CMV was significantly higher in the husbands of women who seroconverted during pregnancy than in the husbands of the women who were seronegative during pregnancy (P < 0.01). Understanding the epidemiology of CMV is a key element in the development of strategies for the prevention of infection. The transmission of CMV by sexual contact may be important in the pathogenesis of congenital infection. Entirely new approaches to the prevention and treatment of congenital CMV infection are necessary, including antiviral interventions and the development of a vaccine strategy. Received: December 14, 1999 / Accepted: April 10, 2000     

南充地区孕妇及新生儿ToRCH感染状况前瞻性调查

目的了解南充地区孕妇及新生儿TORCH感染的状况,为优生优育提供相关信息。方法采用免疫化学发光检测系统测定孕妇及新生儿血清中弓形虫（Tox）、风疹病毒（RUV）、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）（1＋2）特异度kG与IgM抗体。结果所调查的孕妇与新生儿中,ToRCHIgM抗体阳性率分别为16．03％,3．77％;二种以上病原体IgG抗体阳性率分别为80．43％,91．40％。孕妇组ToRCHIgM抗体阳性率分别为1．32％,1．76％,0．55％和13．17％,其中HSV（1＋2）近期感染率最高,秋季感染率相对较低。IgG抗体阳性率分别为5．75％,62．26％,96．74％,89．22％。新生儿组ToRCHIgM抗体阳性率分别为0,0．84％,1．05％和1．89％。IgG抗体阳性率分别为1．47％,51．22％,94．27％和87．32％。结论南充地区育龄妇女和新生儿人群TORCH感染的机率明显存在。和国内其它地区比较,其易感病原体种类存在一些差异。     

Noninvasive prenatal diagnosis of monogenic disorders

INTRODUCTION: Since the presence of circulating cell-free fetal DNA (ccffDNA) in maternal peripheral blood was demonstrated in 1997, great efforts have been done in order to use this source of fetal material for noninvasive prenatal diagnosis. The advantage that it represents is avoiding the obstetric invasive procedures required for conventional prenatal diagnosis. AREAS COVERED: Efforts are mainly focused on finding the most accurate way to diagnose the most common fetal aneuploidies, paying special attention to trisomy 21. Recent advances in technology offer new diagnostic tools with high degrees of sensitivity thus generating great expectations for this type of diagnosis. However, there are other reasons why pregnant women undergo conventional prenatal diagnosis. Being at risk of transmitting a monogenic disorder is one of them. And although the percentage of those pregnancies may represent a small percentage of the diagnosis performed in the first trimester, these numbers should not be underestimated. EXPERT OPINION: Management of pregnancies at risk of an X-linked Mendelian disorder has changed thanks to the noninvasive fetal sex assessment. As for other Mendelian disorders, until recently, their study was limited to those cases paternally inherited. Nevertheless, the new emerging technologies are also opening the scope to maternally inherited disorders.