Antenatal Rubella Research Articles

Parity status and the relationship between antenatal rubella serology with obstetric outcome

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.

Pregnancy After Liver Transplantation: Outcomes From a Single-Center Experience

Although much has been learnt regarding pregnancy after liver transplantation, data from India are scant. Hence, we evaluated the maternal and fetal outcomes of pregnancies after liver transplantation at our center. We conducted a retrospective review of all patients who underwent liver transplantation and later conceived at our center between 2006 and 2019. Of the 750 liver transplantations performed at our center, 129 were female and 62 of them were in the childbearing age group (15-44 years). A total of seven conceptions occurred in seven patients during the study period. All the pregnancies occurred spontaneously. The median age of the patients at the time of liver transplantation and conception was 25 years (range, 24-33 years) and 29 years (range, 26-36 years), respectively. The median interval between transplantation and conception was 40 months (range, 7-48 months). All patients were on tacrolimus monotherapy. None of the patients had rejection during pregnancy despite a low median tacrolimus trough level of 2.7ng/mL. Live birth (five cesarean and one normal) occurred in six of seven pregnancies at a median gestation age of 37.5 weeks. Mean birth weight was 3055.8g (range, 2470-3635g). Antenatal rubella infection and grade III intrauterine growth restriction resulting in still birth at 29 weeks occurred in one patient. The median postnatal follow-up was 25 months (range, 2-81 months). All babies and mothers were healthy. Pregnancy afterliver transplantation has a favorable outcome with a multidisciplinary team approach. There is a physiological reduction of tacrolimus trough levels during pregnancy for which dose augmentation is not usually required.

Epidemiological changes in rubella IgG antibody levels detected in antenatal women from a retrospective rubella seroprevalence study.

Rubella is caused by the rubella virus, a single-stranded RNA virus of the Togaviridae family. The most severe complications of rubella in adult women occur during pregnancy when infection can lead to miscarriage, stillbirth or congenital rubella syndrome. Antenatal rubella susceptibility screening is no longer performed in England, Scotland or Wales but continues in Northern Ireland. The aims of this seroprevalence study were to (1) determine amongst women presenting for antenatal care the percentage of women who are rubella susceptible, rubella immune and those with equivocal rubella antibody levels by year of birth and (2) to consider how rubella vaccination resources can best be utilised. A retrospective study was performed analysing all antenatal rubella IgG antibody tests performed between January 2015 and June 2017 inclusive (n = 19,000; excluding duplicate tests). All antenatal women were included regardless of the country of origin and age. From our analysis, 88.7% (n = 16,868) women had plasma concentrations of anti-rubella IgG > 10IU/ml. 7.3% of women (n = 1403) had rubella IgG levels between 5 and 9.99IU/ml, and 2.8% (n = 729) had IgG levels < 5IU/ml. A decline in rubella immunity in younger women was evident. This study has identified an increase in women who are rubella susceptible and women with equivocal rubella antibody levels. International evidence suggests that rubella serology is unreliable and antenatal screening does not confer any benefit to women during their current pregnancy. Consideration should be given to re-direct resources currently utilised for antenatal screening to facilitate the vaccination of pre-pregnancy and postpartum women and also to opportunistically offer vaccination to all women of childbearing age.

Prior pregnancy and antenatal rubella sero-negativity-evidence of persistent maternal immunologic alteration?

It is unclear if the immunologic alterations induced by pregnancy could persist. Antenatal rubella sero-negativity was correlated with gravidity, abortions and parity in 112083 gravidae managed during 1997-2015, with further analysis stratified for factors known to influence rubella serology. The 10.2% sero-negative gravidae had different characteristics, and the incidence showed significant difference and positive trend (P<.001 for both) with gravidity, abortions and parity. The pattern remained consistent when analysis was stratified for advanced age, high body mass index and medical history, but was negated by hepatitis B virus infection except for abortions, and by high body mass index for parity. For gravidity 2-4, no difference in rubella sero-negativity was found between gravidae with all previous pregnancies ended in abortion vs delivery. Prior pregnancies diminished rubella immunity in a dose-dependent manner, which may be a reflection of the cumulative effect of pregnancy-associated maternal immunologic alteration.

Antenatal Rubella Non-immunity Status and Incidence of Pre-eclampsia

Antenatal Rubella Non-immunity Status and Incidence of Pre-eclampsia

Antenatal rubella non-immunity status and incidence of pre-eclampsia

Antenatal rubella non-immunity status and incidence of pre-eclampsia

Rubella seronegativity in antenatal screening – Is it influenced by the introduction of universal childhood rubella immunization?

ObjectiveThis study examined the impact of rubella immunization, implemented in Hong Kong in phases since 1978, on antenatal rubella serological status in Chinese women. MethodsIn a retrospective cohort study, the incidence of antenatal rubella seronegative status in our parturients managed from 1998 to 2013 was analyzed by their year-of-birth as follows: <1965 (no childhood immunization), 1965–1982 (single dose at Primary 6), and ≥1983 (two doses at age 12 months and 12 years), adjusting for other factors including age, parity, body mass index, place-of-birth status and hepatitis B surface antigen (HBsAg) status. FindingsRubella seronegativity decreased from 12.9%, 10.5%, to 9.8% respectively, and correlated inversely (P<0.001) with year-of-birth cohorts. Despite similar demographic profiles, this correlation was found only in Hong-Kong-born women (from 12.6%, 7.5% to 6.5% respectively), who also had significant lower incidences of rubella seronegativity (OR 0.73, 0.31 and 0.29 respectively) and HBsAg seropositivity (OR 1.09, 0.63 and 0.48 respectively) than China-born women. On regression analysis, rubella seronegativity was actually significantly increased following the implementation of immunization (aOR 1.20) while it was the reverse for non-residents (aOR 0.61). ConclusionAlthough rubella seronegativity decreased with immunization, the effect was less than expected when adjusted for other risk factors.

Maternal Rubella Susceptibility and Autism in Offspring: Case-Control Study of Maternal Non-Immunity and Low Immunity

Objective: Autism may arise from any of several categories of harm, including genetic, environmental, perinatal, and drug exposures. Rubella has been examined as one of the viral causes of autism. We designed a study to determine whether antenatal susceptibility to rubella, shown by low or no immunity when tested in the antepartum, was associated with child autism spectrum disorders. Study Design: Children ages 2.5 years to 7.5 years with autism spectrum disorder were identified, and matched on age and sex with children having no such diagnosis. To identify mothers who were rubella-susceptible, we noted those with pregnancy rubella IgG values under 10 IU/mL; since low-immunity might also pose a risk, we analyzed those with IgG values under 20 IU/mL. Exclusion criteria included preterm delivery, child brain injury or genetic disorder, and maternal use of anti-epileptic or illicit drugs. Results: For the years 2007 to 2011, we identified 56 children with autism meeting study criteria, and identified suitable children as matched controls. Of the 56 autism-case mothers, one had a rubella IgG value under 10 IU/mL, while 6 of the control mothers had an IgG value under 10 IU/mL. For the low-immunity group, 19 of the autism-case mothers had an IgG value under 20 IU/mL, while 18 of the control mothers had an IgG value under 20 IU/mL. These associations were tested with McNemar’s exact (binomial) test. There was no statistical relationship between the presence of an autism diagnosis and mother’s rubella susceptibility at the <10 IU/mL level (p=0.13), and at the <20 IU/mL level (p=0.85). Conclusions: We failed to find evidence supporting the concept that antenatal rubella susceptibility was associated with child autism. Results are not conclusive since this exploratory study was under-powered. We believe that the hypothesis warrants more investigation, including studies with greater power and complementary approaches.

Sero-Prevalence of Antenatal Rubella in UITH

Rubella virus is a teratogen that may induce foetal death or Congenital Rubella Syndrome in the newborn. Studies carried out in Nigeria, have recorded 68.5% prevalence in pregnant women in the south-west and 54.1% in the North-west. There has been a dearth of information in the North central. Sentinel studies have placed the incidence of rubella on a seasonal distribution, with an average of 5-9-year variable epidemic pattern. A descriptive study was carried out on pregnant women between July and September 2009, to establish baseline data on the sero-prevalence of antenatal rubella in pregnant women in Ilorin. A total of 92 pregnant women in the first and second trimesters of pregnancy were recruited from the antenatal clinics of the University of Ilorin Teaching Hospital. A 3ml blood sample was collected from each consenting subject and serum assayed for Rubella IgG/ IgM antibodies by indirect ELISA test. Anti-rubella virus antibodies were reported in the sera of 14 pregnant women that participated in the study. A prevalence of 16.3% was recorded. The primigravidae had a higher prevalence (27.0%) than the multigravidae (12.0%). There was a gradual rise in seroprevalence from first trimester pregnancies (13.0%) to second trimester pregnancies (19.1%). High seroprevalence of rubella infections during organogenesis poses high risk to foetus. Since 85% of the subjects were susceptible to rubella virus infection, it is advisable for health planners to prevent further occurrence of antenatal rubella that may result to congenital rubella anomalies by the immunisation of women of child bearing age.

The impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia.

To describe the impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia, and to identify factors associated with a re-emerging problem. A population-based descriptive study using data from South Australian notifications of disease, births and terminations of pregnancy, the rubella immunisation programme, antenatal rubella antibody screening and paediatric hospital case records. South Australia (population 1.48 million people; 20,000 births per year). Incidence of rubella (age-sex specific), congenital rubella syndrome and rubella-related terminations of pregnancy; antenatal rubella sero-positive rates; rubella immunisation uptake rates. Rubella notification rates in 1990-1996 were significantly higher for males than females for ages 15-34 years. There were five cases of congenital rubella syndrome notified in 1980-1996 compared with at least 20 confirmed or compatible cases in 1965-1979. Rubella-related terminations of pregnancy are now rare, with the last termination for maternal rubella being in 1993. The antenatal rubella sero-positive rate in 1995 was 96.7%, but was significantly lower among Asian women born overseas (78.6% among those 30 years or older). Vaccination uptake rates in schoolgirls decreased between 1990 and 1994 (91.2% to 86.9%). Since the introduction of rubella immunisation, the incidence of rubella infection among women of reproductive age, and of rubella-related terminations, has fallen. Congenital rubella syndrome has not been notified since 1990 but its risk persists with a recent increase in rubella notifications, a fall in school immunisation rates, a relatively low antenatal sero-positive rate among older Asian women born overseas and the trend towards giving birth at older ages. Effective immunisation programmes must be maintained, particularly in schools and for young children and migrant women.