Studies on the management of pregnant women having high hemagglutination inhibition (HI) antibody titer of rubella virus in the first trimester examination of rubella virus antibody in the pregnant women having high HI titer by different methods and prognosis of their infants after birth

Several serological studies of rubella virus (RV) infection were carried out on sera of 45 pregnant women having RV hemagglutination inhibition (HI) antibody titer more than 1:512 in the first trimester, including a follow-up study of these women's pregnancies. In order to detect RV-specific IgM antibody, various procedures were employed as follows: Complement fixation test (CF), HI test after treatment of the sera with Protein-A (ProA-HI), enzyme linked immunosorbent assay (ELISA) by indirect or sandwich procedures and several tests using fractionated sera by sucrose density gradient ultracentrifugation (SDG). Positive ratios found with the CF test and ProA-HI were 26.7% and 20.0%, respectively. In indirect ELISA, 4 cases were positive for RV-specific IgM, but all sera were negative in sandwich ELISA and SDG tests. Both RV isolation from urine of some infants and detection of high RV-specific IgM antibody in cord sera failed to be positive. Of 44 pregnancies, 4 cases resulted in spontaneous abortion and all others in normal delivery. These forty normal infants had no sign of congenital rubella syndrome, but one case among them showed polysyndactyly . The results obtained here seemed to indicate that sandwich ELISA is the most valuable and convenient method among the tested procedures for clinically determined diagnosis of recent RV infection in pregnant women having a high HI antibody titer.     

Rubella and pregnancy: failed prevention policies

Objective: Postpartum rubella immunization can prevent 33–50% of all cases of congenital rubella. Our purpose was to assess missed opportunities for postpartum rubella vaccination.Methods: A retrospective prenatal record review of 304 women attending a high risk obstetrics clinic was done. The rubella status on the first prenatal visit was recorded. Rubella status was determined by immunoassay (ELISA) and reported as immune, uncertain, or nonimmune. For rubella nonimmune women their ethnicity, age, parity, and place of delivery were recorded.Results: Fifteen (4.9%) of the 304 women were nonimmune to rubella. Of the 15 women, 6 were white, 4 were Afro-American, and 5 were Hispanic. The mean age was 30.1 ± 6.2 y (range 20–42 y). Thirteen had given birth at least once (range 1–4), while two were nulliparous. Eleven of the 13 women gave birth in the USA, while two gave birth in South America. These eleven women gave birth 20 times without receiving rubella counseling or vaccination.Conclusion: Recommendation for postpartum rubella vaccination of nonimmune women should be adhered to in order to decrease the risk of congenital rubella syndrome.     

Rubella and the Obstetrician—A Review of Recent Advances

Summary : Recent advances in the diagnosis and prevention of rubella are reviewed. The following are considered: rubella infection in pregnancy and the expanded rubella syndrome; serological diagnosis in the mother and newborn; the place of gamma globulin; the development and side-effects of rubella vaccines; immunization programmes and their limitations; whether live, attenuated rubella virus given just before or during pregnancy is teratogenic; how to investigate such patients and avoid such mishaps; problems with vaccination in the puer-perium; and the place of routine tests for rubella in pregnancy.     

Cytomegalovirus (CMV) and rubella virus infection during pregnancy. A study of CMV and rubella virus antibodies in 2014 pregnant women and follow-up studies of infants at risk for intrauterine CMV infections

Two blood samples, one in the first and one in the third trimester, were collected from 2014 pregnant women. Serological tests for CMV and rubella antibodies were performed in the paired samples. Seroconversion by the CF test for CMV antibodies was demonstrated in 15 women. However, seroconversion also by the IF test was found in only one of these. A rise in titer during pregnancy by the CF test was found in 16 woman. None of these specimens contained specific IgM. High CMV-CF antibody titer (greater than 128) in the first serum sample was found in 28 women, but none of the sera contained specific IgM. It is concluded that no single serological test can serve at present as a screening test for the diagnosis of CMV infection during pregnancy. In children thought to be at risk contracting congenital CMV infection, no case with CNS malfunction that could be attributed to a congenital CMV infection could be demonstrated at the age of 7-8 years. One case of seroconversion in the examination for rubella antibodies was found. The infant of this mother showed no clinical signs of rubella infection.     

Serum soluble urokinase plasminogen activator receptor (suPAR) in early pregnancy prior to clinical onset of preeclampsia

Objective. To examine whether soluble urokinase plasminogen activator receptor (suPAR) in early pregnancy could be a risk marker for later development of preeclampsia. Design. Case-control study. Setting. Hospital-based. Population. The study comprised 43 pregnant women developing preeclampsia (cases) and 86 pregnant women not developing the disorder (controls). Each case was matched with two controls with respect to pre-pregnancy body mass index, gestational age at time of blood collection, storage time of blood samples and maternal age. Methods. The samples had been taken predominantly in the first trimester as part of a routine serological screening for rubella, HIV and toxoplasmosis of Norwegian pregnant women, and were analyzed by a commercially available enzyme-linked immunosorbent suPARnostic? assay kit (ELISA, Virogates, Copenhagen, Denmark). Results. There was no significant difference between median suPAR levels in women who subsequently developed preeclampsia and those who did not (4.5 in the case group vs. 4.3 ng/mL in the control group, p= 0.49). The suPAR levels were relatively high compared with levels in non-pregnant women, reflecting some general physiological responsiveness associated with pregnancy irrespective of preeclampsia. The suPAR level was not related to maternal body mass index, maternal age or sample storage time, nor did it show any association with the following fetal characteristics: body weight, body length, placental weight, delivery method or gender. Conclusion. suPAR did not appear to be a useful early pre-clinical marker of preeclampsia.     

Seropositivity of cytomegalovirus, parvovirus and rubella in pregnant women and recurrent aborters in Leningrad County, Russia.

BACKGROUND: The objectives of this paper were to assess the prevalence of different viral infections in relation to late abortions, stillbirths, and congenital malformations in sera from Russian pregnant women and recurrent aborters in order to establish basic knowledge for future pregnancy care. METHODS: Patients were recruited at the Women's Clinic, Leningrad Regional Hospital during the period March-June 1995. One group of normally pregnant women (Group 1; n=182) and one group of recurrent aborters (Group 2; n=127) were evaluated, including demographic, medical, clinical, and serological data. RESULTS AND CONCLUSIONS: The mean age of the two groups was 27.1 and 28.2 years, respectively. The mean number of deliveries was low (0.4 and 0.5, respectively). Thirty-one point six percent of Group 1 and 41.9% of Group 2 were daily smokers. The group of normally pregnant women had a significantly increased frequency of induced abortions compared to the recurrent aborters, while the recurrent aborters reported more genital infections. There was little difference in total antibodies to cytomegalovirus (CMV) (78.0% and 81.1%, respectively) or B19 IgG (75.3% and 66.9%, respectively) between the groups, while the normal pregnant women had a significantly higher prevalence of rubella antibodies (77.5% and 59.8%, respectively). Our results indicate that less women remain susceptible to primary CMV infection in pregnancy in Russia compared to western Europe and North America. The prevalence of B19 IgG was slightly lower than data from Sweden. Natural immunization against rubella virus was lower than in other, unvaccinated female populations. Vaccination strategies for rubella are now initiated in the Russian Federation. Results from this study are utilized in a federally supported, comprehensive pregnancy care project of North-West Russia.     

妊娠期风疹病毒感染对孕妇及胎儿的影响

目的 探讨妊娠期妇女风疹病毒的感染状况及对胎儿的影响。方法 应用酶联免疫吸附方法对1471例孕妇进行风疹病毒IgG,IgM抗体检测;对其中3例引产和死产的胎儿组织及胎盘行组织切片和电子显微镜检查,并用逆逆录-聚合酶链反应（RT-PCR）技术检测风疹病毒核酸。结果 76.1%(1119/1471)的孕妇风疹病毒IgG阳性;7.4%(109/1471)的孕妇风疹病毒IgM阳性,14.1%(208/1471)的孕妇风疹病毒IgG,IgM阴性;2.4%(35/1471)的孕妇风疹病毒IgG,IgM阳性。7例跟踪随访孕妇中,2例出现死胎,1例要求引产;1例引产胎儿的心肌组织细胞和2例死胎的心肌,肝,脑组织细胞及胎盘中均发现风疹病毒颗粒,并经RT-PCR检测到风疹病毒核酸。结论 妊娠期7.4%的孕妇可感染风疹病毒,并导致胎儿宫内感染,造成胎儿不同程度的损伤或严重的先天性风疹综合征。     

Immunity to rubella among women of child-bearing age

The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Immunity to rubella among women of child-bearing age

Summary. The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Factors associated with low immunity to rubella infection on antenatal screening

BACKGROUND: Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at-risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non-immunity. METHODS: We looked at data on all confinements at two maternity hospitals in Sydney in the 2-year period between July 1999 and June 2001. Variables included in our data set included mother's country of birth, mother's date of birth, hospital status (public or private patient), parity, rubella status and postpartum rubella vaccination. RESULTS: Of the 8096 confinements, the mother was documented as being non-immune to rubella in 567 cases (7%) of cases. Of the 567 confinements where rubella status was documented as non-immune, Asian-born women comprised of 65% (366) of non-immune women while 13% (73) were Australian-born. Country of birth remained a strong predictor of immunity, even after controlling for age, parity and hospital status. Maternal age > 35 years and nulliparity were also significant risk factors for non-immunity. CONCLUSION: Programs targeting underimmunised populations for rubella vaccination should focus on overseas-born women, particularly those born in Asia, nulliparous women and also women > 35 years of age.     

Estimation of fertility and fecundity in women receiving artificial insemination by donor semen and in normal fertile women

Summary. The pregnancy rates after artificial insemination by donor semen (AID) have been compared with pregnancy rates in normal fertile women to assess the efficiency of AID. To do this, the curve y = a (1−(1−b) ^x ) was fitted to life-tabled cumulative pregnancy rates. The equation describes a model in which the parameter a is the proportion of women who are potentially fertile under the conditions of treatment, and in which the parameter b is the pregnancy rate per cycle (or fecundity) of these fertile women. For 259 AID patients with no previous pregnancy a was 65% while for 57 AID patients with a previous pregnancy after AID 'a' was 99.9%. The values of b were similar for the two groups of patients, being 20% and 22% respectively. Women without fertility problems who had become pregnant after discontinuing oral contraception provided the reference group. Since only pregnant women were selected, a was 100% by definition. The values of b for the reference group were 22% for 100 primigravid women and 20% for 100 multigravid women. Only 65% of the AID patients were potentially fertile with AID, but those that were fertile became pregnant at the same rate as normal women who discontinued oral contraception.     

Impact of Vaccination History on Serological Testing in Pregnant Women

Objective

Serological testing guidelines for vaccine-preventable infectious diseases in pregnant women are heterogeneous. It is unclear how vaccination history influences health care workers' (HCWs) attitudes about testing. The aim of this study was to describe current practices in screening for rubella, hepatitis B, and varicella-zoster virus (VZV) in pregnant women in the province of Québec.

Routine Screening for Rubella and CMV Antibodies During Pregnancy: Is it Justifiable?

Background

Rubella and cytomegalovirus (CMV) screening during pregnancy is routinely carried out in India. However, its value has been questioned due to the absence of clearly effective intervention.

Objectives

This retrospective study evaluates the usefulness of rubella and CMV antibody screening during pregnancy.

Materials and Methods

Serum samples received from pregnant women and children were tested for rubella- and CMV-specific IgM antibodies by capture ELISA. The data were analyzed to determine the incidence of rubella and CMV infection during pregnancy and in congenital infections.

Results

In asymptomatic pregnant females (n = 505), rubella positivity was 3.16 % and in women with bad obstetric history (BOH) (n = 220), it was 7.72 %, while CMV positivity was 5.9 % in both asymptomatic pregnant women and in women with BOH. In children (n = 200), the overall positivity for rubella- and CMV-specific IgM antibodies was 15 and 25 %, respectively. A declining trend was observed in the incidence of both rubella and CMV infections in pregnant women and in women with BOH. In children, the incidence of congenital rubella syndrome has declined, but the incidence of CMV infection has remained almost the same in 5 years.

Conclusion

The incidence of rubella has reduced over the past 5 years and can further be prevented by providing direct protection to women and school girls with rubella vaccines. Primary CMV infection in pregnancy is the main problem, and due to the unavailability of efficient and safe treatment, routine antenatal screening for rubella and CMV should be reserved for women with obstetric complications only.     

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy

ObjectiveTo determine the prevalence of anti-rubella virus antibodies and the level of knowledge about congenital rubella syndrome (CRS) among pregnant women living in southern Italy.MethodsA seroepidemiologic study was conducted between July 1, 2006, and December 31, 2007. Five-hundred women resident in Messina were enrolled in the study; the participants were in the 4th to 39th week of pregnancy. Anti-rubella virus antibodies were assayed using a microparticle enzyme immunoassay. Demographic details, vaccination history, and participants’ knowledge of the potential risks of rubella infection during pregnancy were assessed via questionnaire.ResultsOn the basis of the questionnaire results, 70.4% of women were classed as immune to rubella virus infection; however, the prevalence of IgG anti-rubella virus antibodies measured in the participants’ serum was 85.8%. Although 55.2% of women had undergone pre-pregnancy rubella screening, only 81 participants reported that they had been vaccinated before becoming pregnant. The participants’ general knowledge about CRS was poor, as was their understanding of the importance of undergoing screening.ConclusionThe number of women at risk of rubella infection fell short of the national target set for elimination of CRS. Increased involvement and collaboration by all healthcare workers are, therefore, required to disseminate the information necessary to prevent CRS.     

Recurrences of free trisomy 21: analysis of data from the National Down Syndrome Cytogenetic Register

OBJECTIVES: To determine the recurrence risk of a free trisomy 21 pregnancy. METHODS: Data from the National Down Syndrome Cytogenetic Register (NDSCR), which contains information on nearly all cases of Down syndrome between 1989 and 2001 in England and Wales were used. Among 11 281 women with a Down syndrome pregnancy who had had at least one previous pregnancy there were 95 women who had had a previous Down syndrome pregnancy. RESULTS: Women who have had a previous Down syndrome pregnancy have a constant absolute excess risk above their maternal age-related risk of having a subsequent affected pregnancy. This absolute excess risk is determined by the age at which the affected pregnancy occurred and is higher for younger than for older women. For example, after a Down syndrome pregnancy at age 20, this excess is 0.62% (95% CI: 0.24 to 1.15%) at early second trimester, and, after one at age 40, it is 0.04% (95% CI: 0.01 to 0.07%). CONCLUSION: More precise risk estimates by single year of maternal age for use in genetic counselling are provided, but they need validation from other studies before they are incorporated in the risk estimation routines used in Down syndrome screening programmes.     

Immunoglobulin A anti-beta2-glycoprotein antibodies in women who experience unexplained recurrent spontaneous abortion and unexplained fetal death

OBJECTIVE: Studies in rheumatologic populations suggest that immunoglobulin A antiphospholipid antibodies are strongly associated with the clinical manifestations of antiphospholipid syndrome. However, the association between immunoglobulin A antiphospholipid antibodies and pregnancy loss is uncertain. We determined whether immunoglobulin A antiphospholipid antibodies, specifically anti-beta(2)-glycoprotein I and anticardiolipin, are associated with the obstetric features of antiphospholipid syndrome. STUDY DESIGN: Sera from 4 groups of women were studied: (1) 133 women who experienced unexplained recurrent spontaneous abortion, (2) 48 women who experienced unexplained fetal death, (3) 145 healthy fertile control subjects, and (4) 67 women with well-characterized antiphospholipid syndrome. Serum immunoglobulin A, immunoglobulin G, and immunoglobulin M anti-beta(2)-glycoprotein I and anticardiolipin antibodies were determined by enzyme-linked immunoassay. RESULTS: Groups of women who experienced unexplained recurrent spontaneous abortion and unexplained fetal death had a higher proportion of women who had positive test results for immunoglobulin A anti-beta(2)-glycoprotein I antibodies than fertile control subjects (P < .01, chi-square test); these subjects also had higher levels of autoantibody (P = .001, Kruskal-Wallis). Women who experienced recurrent spontaneous abortion had a higher proportion of women with positive test results for immunoglobulin A anticardiolipin antibodies compared to fertile control subjects (P < .05, chi-square test); this group also had higher levels of autoantibody (P = .0065, Kruskal-Wallis test). Linear regression analysis showed significant correlation between anti-beta(2)-glycoprotein I immunoglobulin A and anti-beta(2)-glycoprotein I immunoglobulin G (R = .609; P =.0001) and less correlation between anticardiolipin immunoglobulin A and anticardiolipin immunoglobulin G (R = .093; P = .065). CONCLUSION: Immunoglobulin A anti-beta(2)-glycoprotein I antibodies are more common in women who experience unexplained recurrent spontaneous abortion and unexplained fetal death whose initial test results are negative for lupus anticoagulant and immunoglobulin G anticardiolipin antibodies compared to fertile control subjects. Therefore, these antibodies may identify additional women with clinical features of antiphospholipid syndrome who are not identified through traditional testing. It is unclear whether these antibodies are directly pathogenic, a result of the pregnancy losses, or markers for an underlying, yet uncharacterized autoimmune disorder.     

Rates of Rubella Immunity Among Immigrant and Non-immigrant Pregnant Women

ObjectiveElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of susceptible women of childbearing age. Since many countries do not immunize against rubella, it is possible that some immigrant women may not be immune. Moreover, contemporary estimates of rubella immunity among Canadian-born mothers are lacking.Accordingly, we sought to compare the immunity status in pregnancy of a large number of immigrant and Canadian-born women in Toronto.MethodsWe examined data among 5783 consecutive pregnant women who gave birth at an inner city hospital in downtown Toronto between 2002 and 2007. Antenatal maternal rubella immunity status was recorded at the time of delivery, and assessed according to the mother’s birthplace. Odds ratios (OR) for rubella immunity were adjusted for maternal age, gravidity and duration of residency in Canada.ResultsRelative to a rate of 93.2% among Canadian-born mothers, the adjusted risk of being rubella immune was lowest among women from Northern Africa and the Middle East (OR 0.54, 95% CI 0.31–0.94) and China and the South Pacific (OR 0.78, 95% CI 0.59–1.03).ConclusionRates of rubella immunity are lower than desired among Canadian-born and, especially, new immigrant pregnant women. Under-immunized populations might be identified at the time of the immigration medical examination, while consideration should be given to screening for rubella immunity among all young Canadian women before puberty.     

Leukemia inhibitory factor gene mutations in the population of infertile women are not restricted to nulligravid patients

OBJECTIVE: Leukemia inhibitory factor (LIF) is one of the key cytokines in the embryo implantation regulation. We investigated the prevalence of the LIF gene mutations in the population of infertile women that consisted of nulligravid and secondary infertile patients. STUDY DESIGN: We designed a LIF gene mutation screening method that is based on the Temperature Gradient Gel Electrophoresis (TGGE). The population to screen consisted of 176 infertile women including group A of 147 nulligravid women and group B of 29 women with secondary infertility that had a history of either miscarriage or an ectopic pregnancy but no live births. The control population was comprised of 75 healthy fertile subjects. The groups of fertile controls and infertile patients were compared for statistically significant differences using the t-test. RESULTS: Six potentially functional LIF gene mutations, the G to A transitions at the position 3400 leading to the valin to methionin exchange at codon 64 (V64M) in the AB loop region of the LIF protein, were detected. All of the six positive women were infertile. Four of them were nulligravid and two of them had history of spontaneous conception followed by early miscarriage. No positive TGGE samples were identified in the control group, which means that the frequency of functionally relevant mutations of the LIF gene in infertile women is significantly enhanced in comparison with controls (P<0.05, t-test). CONCLUSION: The results suggest that the LIF gene mutations affect fertility. Even though they occur infrequently, their impact on molecular events during early phases of pregnancy should be further established.