Primary Infection In Pregnancy Research Articles

Human cytomegalovirus (HCMV) long-term shedding and HCMV-specific immune response in pregnant women with primary HCMV infection.

Human cytomegalovirus (HCMV) shedding has been extensively investigated in newborns and in young children, however, much less is known about it in immunocompetent adults. Shedding of HCMV was investigated in saliva, vaginal secretions and urine of pregnant women experiencing primary infection along with the development of the HCMV-specific immune response. Thirty-three pregnant women shed HCMV DNA in peripheral biological fluids at least until one year after onset of infection, while in blood HCMV DNA was cleared earlier. Significantly higher levels of viral load were found in vaginal secretions compared to saliva and urine. All subjects examined two years after the onset of infection showed a high avidity index, with IgM persisting in 36% of women. Viral load in blood was directly correlated with levels of HCMV-specific IgM and inversely correlated with levels of IgG specific for the pentameric complex gH/gL/pUL128L; in addition, viral load in blood was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ expressing IL-7R (long-term memory, LTM) while viral load in biological fluids was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ effector memory RA+(TEMRA). In conclusion, viral shedding during primary infection in pregnancy persists in peripheral biological fluids for at least one year and the development of both antibodies (including those directed toward the pentameric complex) and memory T cells are associated with viral clearance.

Parvovirus infection in fetal life. Case report and recent literature updates

Background. The parvovirus B19 (B19V) belongs to the Parvoviridae family, genus Erythrovirus, and is a virus that causes a common childhood disease called erythema infectiosum, also largely known as the fifth childhood disease. The clinical appearance is marked by the “slapped cheek” facies and an erythematous rash localized mainly on the extremities and on the trunk. Most people gain immunity during childhood, and when it occurs in pregnancy in non-immunized women, there are some serious complications for the fetus that can occur. B19V infection in pregnancy can conduct to fetal loss or severe hydrops fetalis, due to the risk of vertical transmission to the fetus and the virus tropism for the erythropoietic fetal stem cells with subsequent cell destruction and fetal anemia. Invasive treatment, as intrauterine fetal transfusion, is necessary for the cases of severe fetal anemia with good survival rates afterwards. The purpose of this review is to update the current knowledge regarding the best management of severe fetal anemia and other complications related to B19V infection in pregnancy, based on the latest data from literature and guidelines. Methods. Electronic research for relevant articles published in the last years was made, with the usage of PubMed, Medline, Cochrane Data Base, and the current international guidelines promoted by the Obstetrics and Gynecology Societies. Results and conclusions. The importance of prenatal detection of non-immunized women by serologic testing for parvovirus B19 should not be overlooked, and subsequent follow-up should be recommended in order to lower the incidence of fetal complications associated with developing the disease in pregnancy, especially during epidemics. In case of P19V infection in pregnancy, serial ultrasounds and lab tests should be performed in order to determine the impact on the fetus and the apparition of fetal hydrops. The future moms who are not immunized to B19V should be advised about the risk of vertical transmission and the associated fetal sequelae that can occur. Assessment for maternal disease and for fetal impairment has to become a priority when there are signs of primary infection in pregnancy.

Toxoplasma gondii infection in HIV-infected pregnant women: epidemiology and risks of mother-to-child transmission.

Toxoplasma gondii (T. gondii) infects approximately one third of the world's population. Globally there are an estimated 13.1 million cases of T. gondii co-infection in HIV-infected people with 87.1% of these individuals living in sub-Saharan Africa. The risk of T. gondii infection in HIV-infected women rises significantly with lower CD4+ T cell counts (particularly under 100 cells/μl). Mother-to-child transmission (MTCT) occurs in approximately 30% of cases of maternal T. gondii infection during pregnancy. The global prevalence of latent toxoplasmosis in HIV-infected pregnant women is 47.5% but the overall risk in HIV-infected mothers of MTCT of T. gondii is however, estimated to be low at < 5%. MTCT in HIV-infected mothers not only occurs due to T. gondii primary infection in pregnancy but also due to reactivation. Infants with congenital toxoplasmosis born to HIV-infected mother may have a more rapid onset and greater dissemination of disease thus having potentially devastating effects. This article discusses the key risks for MTCT of T. gondii infection in HIV-infected mothers as well highlighting the many knowledge gaps for which further study is required.

First-line noninvasive management of cytomegalovirus primary infection in pregnancy.

To introduce a first-line noninvasive antenatal management of maternal cytomegalovirus (CMV) primary infection based on ultrasound (US) and magnetic resonance imaging (MRI). Amniocentesis (AC) is used as a second-line tool in cases of abnormalities compatible with fetal CMV infection on US and/or MRI screening. Between January 2011 and October 2018, pregnant women referred with a CMV primary infection on antibody screening were followed up by monthly US scans and a brain MRI at approximately 32weeks. In cases with US and/or MRI abnormalities compatible with congenital CMV infection, AC was performed to confirm the diagnosis. Ninety pregnant women with a primary CMV infection were included (89 singleton and one twin pregnancy). The first-line screening by US and/or MRI was normal for 72 of 91 fetuses (79%). At birth, 19 of these 72 neonates (26%) had a positive urine sample for CMV but were asymptomatic. US and/or MRI abnormalities were identified in 19 fetuses (21%). AC confirmed a fetal CMV infection in 16 fetuses (84%); 12 pregnancies were terminated, and four were continued, with three symptomatic neonates at birth and one poor neurodevelopmental outcome at postnatal follow-up. First-line noninvasive management of maternal CMV primary infection based on serial US scans and brain MRI can be offered to identify fetuses with severe symptomatic congenital CMV infection and reduce the number of ACs without compromising the fetal outcome.

CMV-Specific Cell-Mediated Immunity in Immunocompetent Adults with Primary CMV Infection: A Case Series and Review of the Literature.

Cytomegalovirus-specific cell-mediated immunity (CMV-CMI) in actively infected healthy immunocompetent hosts has been poorly investigated. Conversely, correlates of maternal protective immunity for the fetus after primary infection in pregnancy continue to be studied. The kinetics and magnitude of CMV-specific CMI in immunocompetent primary CMV-infected adults are described. A literature review on CMV-CMI in primarily infected pregnant women and its correlation to the risk of vertical virus transmission is included. Immunological measurements after infection were performed by enzyme-linked ImmunoSPOT assay enumerating IFN-γ secreting CMV-specific T cells, at a single cell level, upon in vitro stimulation with viral antigens. Simultaneously, serological and virological profiles of infected patients were investigated. Patients displayed mild-to-moderate clinical and laboratory profiles for infection, and all showed positive EliSpot results in the early stage of infection (<20 days after onset). The virus-CMI was strong in the majority of patients (58.8%) in which the lowest CMV-DNAemia levels (<300 copies/mL) were detected. Significantly higher viral loads were observed in patients with weak CMV-CMI at the same time-point post-infection (up to 15,104 copies/mL; p < 0.001). T cell response magnitudes to IE-1 and pp65-UL83 peptides were overlapping and stable over time. In these case series, the early presence of CMV-CMI was probably pivotal in controlling viral replication and led to spontaneous viral clearance.

Pitfalls in the Serological Diagnosis of Primary Human Cytomegalovirus Infection in Pregnancy Due to Different Kinetics of IgM Clearance and IgG Avidity Index Maturation.

Primary infection occurs when seronegative women are infected by human cytomegalovirus (HCMV). Diagnosis of primary infection is based on the following: antibody seroconversion, presence of IgM and low IgG avidity index (AI), and presence of DNAemia. The kinetics of HCMV-specific IgM antibody and maturation of AI might be very rapid or long-lasting during primary infection, which makes serological diagnosis insidious. The aims of this study were as follows: (i) to report atypical kinetics of HCMV-specific IgM antibody and AI early after onset of primary HCMV infection in a population of pregnant women, and (ii) to assess the frequency of such results. Altogether, 1309 sequential serum samples collected from 465 pregnant women with primary HCMV infection were included in the study. As a general rule, using the LIAISON®CMVIgMII and LIAISON®CMVIgGAvidityII assays, virus-specific IgM antibody levels decreased, while IgG AI increased over time during the first three months after infection onset. However, early clearance of IgM antibody and/or early IgG AI maturation occurred in 46/426 (10.7%) women. In more details, 20/426 (4.7%) and 26/418 (6.2%) women had undetectable IgM antibody or high IgG AI, respectively, when tested within 1–3 months after well-defined infection onset. Twenty sera from as many women with high IgG AI by the LIAISON assay were further tested for IgG AI by VIDAS®CMVIgGAvidityII and Mikrogen recomLineCMVIgG Avidity assays. Comparable results were obtained with VIDAS, whereas 14/20 sera gave low AI with the Mikrogen assay. In conclusion, about 11% of pregnant women undergoing a primary HCMV infection showed misleading serological results. Additional and appropriate testing might help in reducing the risk of missing HCMV primary infection in pregnancy. Furthermore, preconceptional testing should be strongly recommended.

Pregnancy with seropositive toxoplasmosis: a case report

Introduction: Toxoplasmosis is present in every country and seropositive rates vary between regions from less than 10% to more than 90%. Toxoplasmosis in pregnancy can result in severe sequelae to the fetus. Primary infection in pregnancy may cause spontaneous abortion or fetal death in utero. Congenital ocular and neurological abnormalities may also occur. We present a case involving toxoplasmosis infection in early pregnancy and an overview of the management and the clinical outcomes for both mother and fetus.Case report: A 26-year-old pregnant woman (G1P0A0) showed a high concentration of IgG anti-toxoplasmosis in early pregnancy with a concentration of 1200. Throughout the pregnancy, an increase in the concentration of IgG anti-toxoplasma was found. At 14 weeks gestation, concentration increased four-fold to 9068. During the ultrasound observation no hydrocephalus, ocular, and neurological abnormalities were found. Amniocentesis was performed for PCR examination and the result turned out negative. The patient was given spiramycin 1 gram daily for the remaining of her pregnancy. At 40 weeks gestation, the patient gave birth vaginally to a healthy term 3700 grams baby boy. There were no signs of major anomalies found in the baby.Conclusions: Diagnosis and screening of toxoplasmosis require proper understanding of serological examination, as well as the specificity and sensitivity of the diagnostic tools. Ultrasound monitoring for the detection of congenital toxoplasmosis can also help with diagnosis.

Primary cytomegalovirus (CMV) infection in pregnancy: Diagnostic value of CMV PCR in saliva compared to urine at birth

BackgroundDue to its ease of collection saliva was recently recommended as the preferred specimen, not only for screening, but also for diagnosis of congenital cytomegalovirus (CMV) infection. ObjectiveTo compare the diagnostic performance of saliva PCR to urine PCR in infants born to mothers with primary CMV infection during pregnancy. Study designWe retrospectively analyzed available data of infants tested for CMV DNA in urine and saliva at birth. PCR was performed with RealStar® CMV-PCR Kit 1.0 (altona Diagnostics). Infectious virus was detected in urine by rapid culture. ResultsA total of 133 newborns were eligible for final analysis. Saliva swabs and urine were collected at birth with a time interval of 0–8 days (median 0; IQR 0–1). In 55% of newborns, cord blood was also tested. The overall concordance of saliva and urine PCR was 91% (27 positive, 94 negative). In 12 cases with discordant findings the discrepancy was due to false-negative (n = 2) or false-positive (n = 10) PCR results in saliva. Compared to urine, PCR in saliva showed a positive predictive value of 73%. Viral load in saliva was significantly lower (p < 0.0001; Mann-Whitney test) in the 10 false-positive cases than in the 27 cases with concordantly positive results. ConclusionsPositive CMV PCR results in saliva, especially low positive, have to be confirmed by urine testing. In our opinion detection of CMV by PCR in neonatal urine remains the gold standard for diagnosing congenital CMV infection in infants of mothers with primary infection in pregnancy.

Long-Term Sequelae of Congenital Cytomegalovirus Infection are Limited to Maternal Infection in the First Trimester of Pregnancy

Context: Congenital CMV (cCMV) infection is a major cause of sensorineural and neurological disabilities. The aim of the study was to revisit the relationship between gestational age at maternal primary infection and outcome in recent cases (2011-2017) prospectively assessed with accurate virological tools. Methods: Women with a primary infection in pregnancy and an infected fetus and/or an infected child aged at least 1 year at the time of analysis were included prospectively. Accurate determination of the timing of maternal primary infection was based upon serial measurement of a combination of IgM, IgG, IgG-avidity in sera collected in the first, second and third trimester of pregnancy. Assessment of infected children was done according to a structured follow-up from birth up until 48 months. Findings: 255 women/fetus or child pairs were included between 2011 and 2017. Dating of maternal infection was done prospectively in 86% of cases and retrospectively in 14%. At a median follow-up of 24 months, hearing loss and/or neurologic sequelae were seen in 18.2% (35/192) of infected children. The rate of long-term sequelae was 32.4% (35/108) in children infected after a maternal primary infection in the first trimester and 0 (0/79) in children infected after a maternal infection of the second or third trimester (p<.0001). Interpretation: These results suggest that CMV fetal infection is severe only when the virus hits the fetus in the embryonic or early fetal period. Women with seroconversion in the second or third trimester should be reassured on the outcome of fetal infection. Babies infected after maternal primary-infection in the second or third trimester do not need audiological or specialized neurological follow-up. Clinical Trial Number: Cymeval II and Cymepedia Clinicaltrial.gov numbers, NCT01651585 and NCT01923636. Funding Statement: This work was funded by the French government (Direction de la recherche Clinique et Developpement). Declaration of Interests: M.L-V. declares receiving financial support for meeting expenses from BioMerieux outside the submitted work. The remaining authors report no conflict of interest. Ethics Approval Statement: The cohort was built by pooling cCMV cases from 3 different studies which have included patients between 2011 and 2017. The Cymeval II study (11), the Cymepedia study (12) and the BiocCMV study. Ethics committee approved the 3 studies (2011-001610-34; 2013-A00213-42; 2016-14024) and written informed consent was obtained before inclusion. Cymeval II and Cymepedia studies are multicentre studies with 13 recruiting French centers, BiocCMV is a monocentric study in Necker Hospital.

Seroprevalence of Toxoplasma gondii Infection in Refugee and Migrant Pregnant Women along the Thailand-Myanmar Border.

.Toxoplasma gondii primary infection in pregnancy is associated with poor obstetric outcomes. This study aimed to determine the seroprevalence of Toxoplasma infection in pregnant migrant and refugee women from Myanmar attending antenatal care in Thailand. A random selection of 199 residual blood samples from first antenatal screen in 2014–2015 was tested for Toxoplasma IgG and IgM antibodies. Seroprevalence of Toxoplasma infection was 31.7% (95% confidence interval = 25.6–38.4). Avidity testing in the three positive IgM cases indicated all were past infections. Multiparity (≥ 3 children) was significantly associated with higher Toxoplasma seropositivity rates. Seroprevalence of T. gondii infection in this pregnant population is similar to the only other report from Myanmar, where multiparity was also identified as a significant association. Toxoplasma infection is important in pregnant women. Nevertheless, in this marginalized population, this infection may be given less priority, due to resource constraints in providing the most basic components of safe motherhood programs.

Maternal immune correlates of protection from human cytomegalovirus transmission to the fetus after primary infection in pregnancy.

Immune control of primary human cytomegalovirus (HCMV) infection appears to depend on the interaction of humoral and T-cell responses. In this review, we have separately explored the 2 arms of the immune response to primary HCMV infection in HCMV-seronegative pregnant women transmitting (T) or not transmitting (NT) the infection to the fetus, with the objective of correlating the immune risk factors associated with vertical HCMV transmission. As for the humoral response, the following findings were documented: (i) in competitive binding assays, antibody titers to different antigenic sites of the gH pentamer complex were significantly lower in T compared with NT women; (ii) in addition, the number of neutralization sites recognized by T was significantly lower compared with NT women; (iii) the plaque formation inhibition assay showed a faster kinetics and a higher titer in NT women. As for T-cell immunity, the delayed expression of 3 immunological parameters (lymphoproliferative response, CD45RA reexpression in both CD4+ and CD8+ HCMV-specific T cells, and interleukin-2 production by HCMV-specific CD4+ T cells) were significantly associated with vertical transmission. This overview provides important information at the population level, which may help to inform the evaluation of interventions such as vaccination or treatments designed to interrupt intrauterine transmission of HCMV during primary infection. However, although we are waiting for an HCMV vaccination to become available, we emphasize that none of these parameters can be prognostically used on an individual basis because of the great variation in values among women.

Neutralizing and ELISA IgG antibodies to human cytomegalovirus glycoprotein complexes may help date the onset of primary infection in pregnancy

BackgroundDefinition of onset for primary human cytomegalovirus (HCMV) infection during pregnancy is critical for several reasons, including diagnosis of pre-conceptional infections and definition of gestational age at the time of infection. ObjectiveTo determine the onset of primary HCMV infection, differential kinetics of antibodies neutralizing infection of epithelial and fibroblast cells, as well as ELISA IgG antibodies to HCMV glycoprotein complexes (gC) gH/gL/pUL128L, gH/gL/gO, and gB were exploited and compared with conventional assays. Study designIn a series of 40 pregnant women with primary HCMV infection and ascertained HCMV-related mild clinical symptoms, the kinetics of different types of neutralizing and ELISA IgG antibodies were investigated with the aim of establishing criteria for dating the onset of primary infection in pregnant women without clinical symptoms. ResultsIgG antibodies to gB and gH/gL/pUL128L, as well as antibodies neutralizing infection of epithelial cells appeared early after infection onset (within 2–3 weeks) and increased rapidly, whereas antibodies to gH/gL/gO and antibodies neutralizing infection of fibroblasts appeared later (>30 days) and increased slowly. Both the conventional diagnostic assays (IgG, and IgM antibody, and IgG avidity index) and the novel assays for determination of antibody responses directed against HCMV gC allowed the definition of an algorithm indicating the onset of primary HCMV infection in asymptomatic women within a period of 1–2 months. ConclusionNew neutralization and ELISA IgG assays to HCMV gC provide additional tools for dating the onset of primary infection in pregnancy.

Management of varicella-zoster virus primary infection during pregnancy: A national survey of practice

BackgroundVaricella (VZV) infection in pregnancy can result in serious outcomes: maternal pneumoniae irrespective of the term of pregnancy, and lead to congenital varicella syndrome before 18 weeks of gestation and neonatal varicella. There are between 350 and 500 cases a year in France. Until now, there have been no scientific obstetrical guidelines for clinical practice in France for VZV infection during pregnancy. ObjectivesTo evaluate health care providers’ knowledge and practices concerning varicella infection during pregnancy in France. Study designAn anonymous survey on VZV infection was sent by e-mail to gynecologists-obstetricians and midwives. We evaluated their knowledge and practices concerning VZV transmission, maternal varicella, congenital varicella syndrome, neonatal varicella and prevention. ResultsThe survey was completed by 271 professionals: gynecologists (161/271; 60%) and midwives (110/271; 40%). Among 20 items, 5 were multiple choice questions. 29 correct answers were expected. Scores ranged from 6/29 to 28/29 (mean score: 17.44/29). ConclusionsThe consequences of VZV primary infection in pregnancy are poorly known. We reveal a diversity of management among practitioners in our study population, not always in accordance with the international scientific literature or with the guidelines of other countries. Health care providers should update their knowledge of varicella infection during pregnancy. The publication of national guidelines could help to achieve this objective.

An effective and feasible approach to prevention of primary cytomegalovirus infection in pregnancy

In the absence of a cytomegalovirus (CMV) vaccine, other strategies for prevention of primary infection in pregnancy should be considered. Behavioural interventions have been reported to significantly decrease seroconversion rate among seronegative pregnant women. We report here on a recently completed controlled study in which seronegative women at high risk of infection because of close contacts with children &amp;lt;36 months, were identified and informed about risky and protective behaviours. Informed women seroconverted at a significantly lower rate than non-informed women.

OC21.02: Lesion size affects the diagnostic performance of the International Ovarian Tumor Analysis (IOTA) logistic regression models, the IOTA simple rules and the risk of malignancy index to estimate the risk of malignancy in adnexal masses

Objectives: Positive CMV IgM in the first trimester of pregnancy mandates IgG avidity assays to exclude or confirm primary infection in pregnancy. Methods: To correlate IgG avidity index actual values and trends with the risk of fetal infection. Sera were obtained from women in the first trimester of pregnancy. CMV serology was performed with the LIAISON CMV IgG kit and the LIAISON CMV IgM. Kit. Positive IgG (>0.6 UI/mL) and equivocal IgM (≥15 UA/mL and <30 UA/mL) or positive IgM (≥ 30 UA/mL) prompted CMV IgG avidity test. LIAISON CMV IgG Avidity assay and VIDAS CMV IgG Avidity assay were used in parallel and results were interpreted as recommended by the manufacturer (PI less than 3 months, PI more than 3 months, Intermediate). When at least one of the 2 avidity results was in favour of a PI dating back more than 3 months, the patient was reassured, in all other cases amniocentesis was recommended for prenatal diagnosis after 20 weeks. Results: 187 women (256 sera) had positive or equivocal IgM. Avidity index values were correlated (r2 = 0.646) but there was only 48% concordance in avidity test interpretations. 61 women (77 sera) had an avidity index low or intermediate in LIAISON or VIDAS CMV IgG Avidity assays. 15 of these 61 women (24.5%) had a positive CMV PCR in amniotic fluid retrieved between 19 and 25 weeks. Logistic regression of IgM levels and LIAISON avidity index values did not show any significant association with fetal infection but VIDAS avidity index values were inversely statistically associated with fetal infection (P = 0.002). Based on this logistic regression model the risk of fetal transmission was 70, 40% and 20% for VIDAS avidity index below 0.10, at 0.2, and at 0.4 respectively. Conclusions: These results could be useful for more accurate counselling of women presenting with positive CMV IgM in the first trimester to help them choose between amniocentesis at 20 weeks or ultrasound follow-up alone.

Efficacy of Rapid Treatment Initiation Following Primary Toxoplasma gondii Infection During Pregnancy

Treatment of Toxoplasma gondii infection acquired during pregnancy differs in many countries. In Germany, spiramycin is given until the 16th week of pregnancy, followed by at least 4 weeks of combination therapy with pyrimethamine, sulfadiazine, and folinic acid independent of the infection stage of the fetus. If infection of the fetus is confirmed by polymerase chain reaction or if fetal ultrasound indicates severe symptoms (hydrocephalus, ventricular dilation), treatment is continued until delivery with regular monitoring of pyrimethamine and sulfadiazine concentration in maternal blood and observation of possible adverse effects. In other European countries, such as France, only spiramycin is given unless infection of the fetus is proven. To evaluate the effectiveness of the German treatment scheme, a retrospective analysis of 685 women who showed a serological constellation consistent with primary infection in pregnancy and their children was performed. We found an increased transmission rate to the fetus with increased time in gestation and a decreased risk of clinical manifestations. In comparison with studies performed in other countries, the overall transmission rate (4.8%) and the rate of clinical manifestations in newborns (1.6%) were lower. Use of spiramycin from time of diagnosis of acute acquisition of infection by the pregnant woman until week 16, followed by pyrimethamine, sulfadiazine, and folinic acid for at least 4 weeks in combination with a standardized follow-up program is efficient in reducing transplacental transmission of the parasite and the burden of disease in the newborn.

Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection: A 20-year experience

Background The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990–2009). Results Overall, 25.6% women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4% cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9% cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5% women. The onset of infection could be established, and counseling adjusted accordingly in >90% cases. The overall rate of vertical transmission was 37.1%, ranging from 5.6% for preconceptional infections to 64.1% for third trimester infections. Amniocentesis was chosen by 43.1% women, whereas pregnancy termination was requested by 15.6%. Conclusions Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information.

Is preeclampsia an infectious disease?

Studies have suggested a strong paternal factor in the etiology of preeclampsia. If preeclampsia is caused by an infectious agent transmitted by the woman's partner, seronegative women who may experience primary infection in pregnancy should be at increased risk of preeclampsia as compared to previously infected women. The aim of this study was to assess the impact of being seronegative for some viruses transmitted by close contact on the risk of developing preeclampsia. Nine hundred and seventy-eight women were randomly drawn from a basic study population of 35,940 pregnant women in Norway. A serum sample drawn at the first antenatal visit was analyzed for specific IgG antibodies against herpes simplex virus type-2, cytomegalovirus and Epstein-Barr virus. For comparison, antibody status against Toxoplasma gondii was also assessed. Information on preeclampsia in pregnancy was obtained through linkage to the Medical Birth Registry of Norway. Thirty-three (3%) women developed preeclampsia. The risk of developing preeclampsia seemed to be increased for women who were seronegative for the viruses studied. Seronegativity for Toxoplasma gondii did not show such a pattern. Women who are seronegative for antibodies against viral agents transmitted through close contact seem more likely to develop preeclampsia. This finding indicates that women who are seronegative to such agents may acquire primary infection in pregnancy, and subsequently be at increased risk of preeclampsia. This hypothesis could represent a new approach to the causes of preeclampsia, and encourage search for yet unidentified microbes as a possible causal factor.

Is preeclampsia an infectious disease?

Background. Studies have suggested a strong paternal factor in the etiology of preeclampsia. If preeclampsia is caused by an infectious agent transmitted by the woman’s partner, seronegative women who may experience primary infection in pregnancy should be at increased risk of preeclampsia as compared to previously infected women. The aim of this study was to assess the impact of being seronegative for some viruses transmitted by close contact on the risk of developing preeclampsia. Methods. Nine hundred and seventy-eight women were randomly drawn from a basic study population of 35,940 pregnant women in Norway. A serum sample drawn at the first antenatal visit was analyzed for specific IgG antibodies against herpes simplex virus type-2, cytomegalovirus and Epstein-Barr virus. For comparison, antibody status against Toxoplasma gondii was also assessed. Information on preeclampsia in pregnancy was obtained through linkage to the Medical Birth Registry of Norway. Results. Thirty-three (3%) women developed preeclampsia. The risk of developing preeclampsia seemed to be increased for women who were seronegative for the viruses studied. Seronegativity for Toxoplasma gondii did not show such a pattern. Interpretation. Women who are seronegative for antibodies against viral agents transmitted through close contact seem more likely to develop preeclampsia. This finding indicates that women who are seronegative to such agents may acquire primary infection in pregnancy, and subsequently be at increased risk of preeclampsia. This hypothesis could represent a new approach to the causes of preeclampsia, and encourage search for yet unidentified microbes as a possible causal factor.

Do antepartum herpes simplex virus cultures predict intrapartum shedding for pregnant women with recurrent disease?

OBJECTIVE: To examine antenatal screening as a predictor of intrapartum shedding of herpes simplex virus (HSV) and to determine its usefulness in guiding the appropriate route of delivery for patients with recurrent HSV in pregnancy. METHODS: A population of 198 pregnant women with a history of recurrent genital HSV were cultured in the last weeks of their pregnancy by specially-trained personnel and intrapartum by their delivering attendants. RESULTS: Of cultures from a total of 906 antenatal visits, 17% were culture positive, with an asymptomatic shedding rate of 3.4%. Asymptomatic shedding occurred in 12.6% of women. Over the 8-week antepartum period, viral culture-positivity rates for each visit ranged from 11% to 19.5%. This provided an expected delivery culture-positivity rate of 15.3%. However, actual intrapartum viral culture positivity occurred in only three of 191 women (1.5%; P < 0.001). Because previous studies have suggested antepartum culture positivity fails to predict intrapartum viral shedding, evaluations, including cultures, as well as predictive values for subsequent culture positivities, were determined under the supervision of an infectious disease specialist. Under these conditions, positive predictive values were 59% when the interval between visits was 2 days, but only 19% when days between visits were >2 (P < 0.0001). No cases of neonatal herpes were seen in this population, although cesarean deliveries were performed in 31% of the patient population, with genital herpes as the indication for 56% of those. CONCLUSIONS: Antepartum serial screening by viral culture is not predictive of an infant's risk of intrapartum viral exposure when conducted at weekly intervals. However, more frequent assessments of patients can be predictive of an infant's exposure risk to HSV; for patients with frequent recurrent disease near term or primary infection in pregnancy, frequent late antepartum screening may be appropriate.