Abstract
Routine antenatal rubella serological testing is adopted in many countries. In a population covered by universal childhood rubella immunization for four decades, we have observed an association between pre-eclampsia with maternal rubella seronegativity among multiparous gravidae. This retrospective cohort study was further performed to elucidate the interaction between parity status and rubella seronegativity on obstetric outcome in singleton pregnancies carried to ≥ 24 weeks gestation managed from 1997 to 2019, with the data retrieved from a computerized database used for annual statistics and auditing. Of the 133,926 singleton pregnancies eligible for the study, the 13,320 (9.9%) rubella seronegative gravidae had higher mean booking weight and body mass index (BMI), but shorter height, and higher incidence of advanced age (≥ 35 years), high BMI, short stature, and lower incidence of nulliparas. Univariate analysis showed that adverse obstetric outcomes were more frequently found among the multiparas. On multivariate analysis, there was increased postdated (> 41 weeks) pregnancy irrespective of parity status, while nulliparas had reduced gestational hypertension (aRR 0.714, 95% CI 0.567–0.899) and gestational diabetes (aRR 0.850, 95% CI 0.762–0.950), and multiparas had increased pre-eclampsia (aRR 1.261, 95% CI 1.005–1.582), neonatal death (aRR 2.796, 95% CI 1.243–6.291), and perinatal death (aRR 2.123, 95% CI 1.257–3.587). In conclusion, in a population covered by universal childhood rubella immunization, antenatal rubella seronegativity is associated with increased pre-eclampsia and perinatal loss only in multiparas, suggesting that the rubella seronegativity in these women served as proxy for some form of altered immune response which increases adverse pregnancy outcome.
Highlights
Routine antenatal rubella serological testing is adopted in many countries
We have found that rubella seronegative status was associated with increased PE among multiparous but not nulliparous gravidae[12], suggesting that rubella sero-negativity in our population could be a surrogate for subtle differences in maternal immune status which could predispose towards PE
There was no significant difference in the mean maternal age (Table 1), rubella seronegative gravidae had significantly higher mean booking weight and body mass index (BMI) but shorter height, and had higher incidence of advanced age (RR 1.162, 95% confidence intervals (CI) 1.128–1.197), high BMI (RR 1.244, 95% CI 1.208–1.280), short stature (RR 1.120, 95% CI 1.089–1.152), but lower incidence of nulliparous women (RR 0.919, 95% CI 0.902–0.937)
Summary
Routine antenatal rubella serological testing is adopted in many countries. In a population covered by universal childhood rubella immunization for four decades, we have observed an association between pre-eclampsia with maternal rubella seronegativity among multiparous gravidae. In a population covered by universal childhood rubella immunization, antenatal rubella seronegativity is associated with increased pre-eclampsia and perinatal loss only in multiparas, suggesting that the rubella seronegativity in these women served as proxy for some form of altered immune response which increases adverse pregnancy outcome. Different maternal cytokine profiles were found to associate with pregnancy c omplications[16], and whether rubella sero-negativity among vaccinated women could be proxy to some form of underlying differences in maternal immunological status remains an unanswered question We performed this retrospective cohort study to compare obstetric outcomes between rubella seronegative with seropositive gravidae to determine if rubella immunity status has any bearing on pregnancy outcome in addition to the influence on PE as reported b efore[12]
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