Parvovirus B19 Infection in Pregnancy: Implications for Childhood Outcomes?

Vibhuti Shah,Amish Jain,Edmond Kelly

doi:10.2174/1874279300903010083

Abstract

Background: Maternal parvovirus B19 infection can lead to serious consequences in the fetus including fetal death, non-immune hydrops fetalis and possibly long-term adverse neurodevelopmental outcome. To date, there has been no systematic review of the literature regarding long-term outcomes of these infants and children. Objective: To systematically review the literature on the long-term neurodevelopmental outcomes of infants and children born to mothers with acute parvovirus B19 infection in pregnancy. Methods: Electronic databases MEDLINE, EMBASE, CINAHL, PsychInfo, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CCRT) were searched to identify studies that reported on long-term neurodevelopmental outcome of infants and children born following maternal parvovirus B19 infection in pregnancy. No language restrictions were applied. Data synthesis was performed using qualitative description and was categorized based on 1) outcome of infants and children with clinical presentation of non-immune hydrops fetalis and 2) outcomes of infants and children born to mothers with serologic evidence of acute infection. Results: Eleven studies were included. Five studies reported on outcomes in infants and children with non-immune hydrops fetalis while six studies reported on outcomes in infants and children born to mothers with serologic evidence of acute infection. There is a suggestion that the incidence of adverse neurodevelopmental outcome is higher in those who present with non-immune hydrops fetalis (18% (7/39), range from individual studies 0-31.3%) compared to asymptomatic infants and children born to mothers with acute parvovirus B19 infection in pregnancy (2.4% (12/494) range from individual studies 0-7.4%). Conclusion: Even though the outcome of parvovirus B19 in pregnancy in most cases is favorable, there is some supportive data that fetal parvovirus B19 infection can cause central nervous system damage. Future prospective studies needs to be conducted to address this issue.

Highlights

Maternal parvovirus B19 infection can lead to serious consequences in the fetus including fetal death, non-immune hydrops fetalis and possibly long-term adverse neurodevelopmental outcome
non-immune hydrops fetalis (NIHF) associated with poor outcome in terms of mortality Interpretation regarding longterm outcome limited due to single survivor
Children with successful intrauterine transfusion (IUT) have good neurodevelopmental outcome Limitations: 1) Conclusion based on small number of participants 2) Different values of scores reported in the abstract and the results section

Summary

Introduction

Maternal parvovirus B19 infection can lead to serious consequences in the fetus including fetal death, non-immune hydrops fetalis and possibly long-term adverse neurodevelopmental outcome. Since the link between maternal parvovirus B19 infection and nonimmune hydrops and fetal death has been well established [4,5,6,7]. The virus attaches to the “P” antigen that is linked to intracellular lytic and/or apoptotic pathways leading to cellular destruction and permitting viral replication [8]. The “P” antigen has been identified on erythroid progenitor cells, megarkaryocytes, endothelial cells, placental cells and fetal liver and myocardial cells which are involved in the complex of symptoms that characterize the infection.

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Conclusion