Virus Infection In Pregnant Women Research Articles

Hepatitis B Virus Infection in Pregnant Women, in Al Fashir Town, North Darfur State, Sudan

Background: Sudan is a highly endemic country for hepatitis B virus (HBV). Screening for HBV during pregnancy may help to decide on appropriate antiviral therapy and the institution of steps to minimize vertical transmission to the newborns. Of the epidemiological studies carried in different regions of Sudan, few are available regarding pregnant women. In Darfur region such data is absent, so our aim was to evaluate seroprevalence of HBV among antenatal care attendants in Al Fashir town. Method: A cross sectional study was conducted between 2013 and 2015. Blood samples were collected from 900 pregnant women attending antenatal clinics in Al Fashir town. Plasma was separated and tested for markers of HBV (HBcAb, HBsAg, HBeAg, HBeAb) using ELISA. Sociodemographic, obstetrics and medical data were collected using structured questionnaires. Results: AntiHBc was detected in 46% and HBsAg was detected in 18% of study population. HBeAg and HBeAb frequencies were found to be 2.6% and 37.7% among positive HBsAg pregnant women. There was significant association between residence, income, occupation, bloodletting and ear piercing with HBV infection (P Conclusion: The results of the study suggest that HBsAg has a high prevalence among the pregnant women in Al Fashir town, North Darfur State. So, to minimize vertical transmission, antenatal women must be routinely screened for HBV.

Mid-arm muscle area and anthropometry predict low birth weight and poor pregnancy outcomes in Tanzanian women with HIV

BackgroundAn observational study was conducted to examine the role of maternal anthropometry, including mid-arm muscle area (MAMA) and others, as risk factors for low birth weight (LBW), small for gestational age (SGA) and preterm births in human immunodeficiency virus (HIV) infected pregnant women. HIV-positive women (N = 2369), between 12 and 32 weeks gestation were followed through delivery in Tanzania, from 2003 to 2008. Participants were women enrolled in a randomized, double-blind, placebo-controlled, clinical trial who delivered live births.MethodsBinomial regression analysis was used to evaluate the association of maternal nutritional indicators of MAMA, mid-upper arm circumference (MUAC), body mass index (BMI) and maternal weight with LBW, SGA and preterm in multivariate analysis.ResultsHigher MAMA was associated with a 32% lower risk of LBW compared to lower measurements (RR = 0.68, 95% CI = 0.50–0.94). Similar protective associations were noted for higher BMI (RR = 0.58, 95% CI = 0.42–0.79); maternal weight (RR = 0.50, 95% CI = 0.36–0.69) and MUAC (RR = 0.62, 95% CI = 0.45–0.86). Higher MAMA was also associated with lower risk of SGA (RR = 0.78, 95% CI = 0.68–0.90) and marginally associated with preterm (RR = 0.85, 95% CI = 0.69–1.04). Beneficial associations of MUAC, BMI and maternal weight with SGA and preterm were also observed.ConclusionMAMA performs comparably to MUAC, maternal weight and BMI, as a predictor of LBW and SGA in HIV-infected women. The possible role of MAMA and other indicators in screening HIV positive women at risk of adverse pregnancy outcomes should be investigated.

Sexual Behaviors of Human Immunodeficiency Virus-Infected Pregnant Women and Factors Associated With Sexually Transmitted Infection in South Africa.

Sexual behaviors in human immunodeficiency virus (HIV)-infected pregnant women in South Africa are not well understood. Human immunodeficiency virus-infected pregnant women were recruited into a prospective cohort at first antenatal care visit. Sociodemographic information and self-collected vulvovaginal swab samples were collected from participants. Vulvovaginal swab samples were tested for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis using GeneXpert. We investigated sexual behaviors, alcohol use, factors associated with condomless sex during pregnancy, and prevalent sexually transmitted infection (STI) among our cohort. We report descriptive, univariate and multivariable logistic regression results of sexual behaviors and alcohol use, factors associated with condomless sex at last sex, and having any STI during pregnancy adjusting for a priori confounders. We recruited and enrolled 430 HIV-infected pregnant women. Median age was 30 years; median gestational age was 20 weeks. Eighty-nine percent of women reported sex during pregnancy. At last sex, 68% reported condomless sex; 18% reported having more than 1 sex partner in the past 12 months. Adjusting for age, income and relationship status, condom use at last sex was associated with prior knowledge of HIV status (adjusted odds ratio [aOR], 2.46; 95% confidence interval [CI], 1.54-3.92) and being in a concordant HIV-positive (aOR, 3.17; 95% CI, 1.84-5.50), or serodiscordant relationship (aOR, 6.50; 95% CI, 3.59-11.80). The prevalence of any STI was 41% (95% CI, 36%-45%). Adjusting for mothers' age and employment, odds of having an STI increased if the woman reported alcohol use during pregnancy (aOR, 1.96; 95% CI, 1.06-3.64) or if the father of the child was a non-cohabiting or casual partner (aOR, 1.42; 95% CI, 0.97-2.03). Almost all HIV-infected pregnant women were sexually active during pregnancy and most women reported condomless sex at last sex. Condom use was associated with knowledge of serostatus and/or partner's serostatus before first antenatal care visit. Factors associated with having STIs included: alcohol use during pregnancy and father of child being a non-cohabiting partner.

Seroprevalence and factors associated with Hepatitis B virus infection in pregnant women attending antenatal clinic in Karagwe district council, Tanzania

Seroprevalence and factors associated with Hepatitis B virus infection in pregnant women attending antenatal clinic in Karagwe district council, Tanzania

Prevalence of Zika, dengue and Chikungunya virus infection in pregnant women and surveillance of congenital Zika infection in Salvador, Brazil

Background: An unprecedented outbreak of Zika virus (ZIKV) occurred in Brazil in 2015. Approximately 18,372 cases were notified in the city of Salvador, located in the state of Bahia in northeastern Brazil. Methods & Materials: Beginning in February 2016, active hospital surveillance for congenital Zika virus infection and a cross-sectional study at a reference maternity hospital were initiated to evaluate the prevalence of recent and previous infections by ZIKV, Dengue and Chikungunya virus in pregnant women as well as congenital infection by ZIKV in newborns. Results: To date, we have enrolled 224 women and 223 newborns. The mean age of women is 25 ± 6 years, with 146 (61%) reporting an exanthematous illness during pregnancy. The majority of these cases occurred between February and April 2016. Most babies were born by vaginal delivery (60%) at gestational age of 37.4 ± 5 weeks. Most (53%) of the newborns were male and 48 (21.5%) were diagnosed with microcephaly. Of these, 16 (33%) were admitted to a neonatal intensive care unit and four (8.3%) died. Many women (n = 133) were tested by ELISA IgG for Zika, Dengue and Chikungunya at the time of delivery. The majority (94%) were Dengue IgG positive, 94 (71%) were Zika IgG positive and 39 (28.6%) presented Chikungunya IgG positivity. Positive ELISA IgM for Zika in mothers and newborns was 7.4% and 5.6% respectively. ZIKV RT-PCR was performed in 114 samples from newborns (umbilical cord blood and urine), yielding 17 (15%) positive results, five of which were from microcephalic babies, while 12 were normocephalic. ZIKV RT-PCR positivity was 19.2% in microcephalic newborns and 13.6% in normocephalic newborns. Conclusion: In light of these findings, we suggest that microcephaly should be considered a severe form of congenital Zika infection, and that less severe presentations should also be evaluated. We intend to further characterize the clinical manifestations associated with congenital ZIKV infection in a prospective follow-up study involving the babies with congenital ZIKV infection (with and without microcephaly) to more comprehensively describe the clinical manifestations, complications and natural history associated with ZIKV.

Attitudes and perceptions of pregnant women towards the use of Anti-Retroviral Therapy in Nigeria

BackgroundMother-to-child transmission of Human Immunodeficiency Virus continues to be a major problem in Nigeria. Despite several initiatives, the number of infected pregnant women receiving Anti-Retroviral Therapy to prevent mother-to-child transmission of the virus remains low in Nigeria. Evidence suggests that attitudes and perceptions of the pregnant women influence their use of Anti-Retroviral Therapy. AimTo understand the attitudes and perceptions of Human Immunodeficiency Virus infected pregnant women towards the use of Anti-Retroviral Therapy for prevention of mother-to-child transmission in Nigeria. MethodTwenty four Human Immunodeficiency Virus infected pregnant women were purposively selected from antenatal clinics. Women’s attitudes and perceptions towards the use of Anti-Retroviral Therapy were explored using semi-structured in-depth interviews conducted in May/June 2016. All interviews were recorded, transcribed and analysed using thematic approach. FindingsOverall, participants reflected a positive attitude about using Anti-Retroviral Therapy to prevent mother-to-child transmission and perceived the treatment as beneficial. The main themes identified included: perceived benefits of Anti-Retroviral Therapy; barriers to using Anti-Retroviral Therapy; threat from the susceptibility to the illness and the severity; perceived roles in treatment; and the negative behaviours of healthcare providers. ConclusionThe findings provide useful insights to inform Nigeria’s health policies on Anti-Retroviral Therapy. There is a need to educate the women on the benefits of the treatment as well as how they can cope with side effects and the daily regimen of the therapy during pregnancy. The findings also indicate the need for training healthcare providers on facilitative patient-provider relationship.

Increased oestradiol in hepatitis E virus-infected pregnant women promotes viral replication.

Hepatitis E virus (HEV) infection causes subclinical diseases, leading to high mortality (>25%) in pregnant women. HEV replication is aggressively escalated in pregnant women, especially in the third trimester of pregnancy. Oestrogen plays an important role in pregnancy. However, the pathogenesis of HEV in pregnant women or immunosuppressive pregnant women (such as HIV-infected or organ-transplanted pregnant women) remains unclear. We investigated the role of oestradiol in HEV infection in a cell culture system. HEV-infected pregnant women had significantly higher oestradiol levels compared with uninfected individuals. HEV infection was significantly increased in cells treated with analogues of oestradiol, diethylstilbestrol (DES) or 17β-oestradiol in a dose-dependent way. However, tamoxifen, an antagonist oestrogen, inhibited HEV replication. HEV infection inhibits oestrogen receptor (ER-α) expression. Immunofluorescence and co-immunoprecipitation assays indicated that ER-α interacted with the helicase of HEV ORF1 indirectly. More importantly, HEV infection was exacerbated in immunosuppressive cells treated with an inhibitor of PI3K-AKT-mTOR signal pathway (LY296004) and supplemented with pregnant women serum with high oestradiol simultaneously. These results strongly suggest that pregnant women with high oestradiol and/or immunosuppression will be vulnerable to HEV infection.

Hepatitis B virus infection in pregnant women – a retrospective study

Hepatitis B virus infection in pregnant women – a retrospective study

The prevalence and risk factors for Trichomonas vaginalis infection amongst human immunodeficiency virus-infected pregnant women attending the antenatal clinics of a university teaching hospital in Lagos, South-Western, Nigeria.

Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted infection worldwide. Interactions between this infection and human immunodeficiency virus (HIV) may cause adverse pregnancy outcomes such as preterm labour, premature rupture of membranes, chorioamnionitis, low birth weight and post-abortal sepsis. This study was aimed to determine the prevalence and risk factors of T. vaginalis infection amongst HIV-positive pregnant women attending antenatal care at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. This was an analytical cross-sectional study in which 320 eligible participants which included 160 HIV-positive (case group) and 160 HIV-negative (control group) pregnant women were recruited at the antenatal clinic of LUTH. A structured pro forma was used to collect data from consenting participants after which high vaginal swabs were collected, processed and examined for T. vaginalis. The association between categorical variables was tested using the Chi-square test and Fisher's exact test where applicable. All significances were reported at P < 0.05. The prevalence of T. vaginalis infection amongst HIV-positive and HIV-negative pregnant women were 10% and 8.1%, respectively (P = 0.559). Significant risk factors for T. vaginalis infection in the HIV-positive pregnant women were early coitarche (P < 0.005) and multiple lifetime sexual partners (P = 0.021). There was no relationship between the T. vaginalis infection and the immunological markers of HIV infection. While this study does not provide grounds for universal screening of pregnant women for T. vaginalis infection as a tool of reducing HIV acquisition, especially in pregnancy, campaign to create better sexual health awareness should be commenced as a way to contributing to the reduction in T. vaginalis infection during pregnancy and perinatal transmission of HIV.

Distinct T and NK cell populations may serve as immune correlates of protection against symptomatic pandemic influenza A(H1N1) virus infection during pregnancy.

Maternal influenza infection during pregnancy is associated with increased risk of morbidity and mortality. However, the link between the anti-influenza immune responses and health-related risks during infection is not well understood. We have analyzed memory T and NK cell mediated immunity (CMI) responses in pandemic influenza A(H1N1)pdm09 (pdm09) virus infected non-vaccinated pregnant women participating in the Norwegian Influenza Pregnancy Cohort (NorFlu). The cohort includes information on immunization, self-reported health and disease status, and biological samples (plasma and PBMC). Infected cases (N = 75) were defined by having a serum hemagglutination inhibition (HI) titer > = 20 to influenza pdm09 virus at the time of delivery, while controls (N = 75) were randomly selected among non-infected pregnant women (HI titer <10). In ELISpot assays cases had higher frequencies of IFNγ+ CD8+ T cells responding to pdm09 virus or conserved CD8 T cell-restricted influenza A virus epitopes, compared to controls. Within this T cell population, frequencies of CD95+ late effector (CD45RA+CCR7-) and naive (CD45RA+CCR7+) CD8+ memory T cells correlated inversely with self-reported influenza illness (ILI) symptoms. ILI symptoms in infected women were also associated with lower numbers of poly-functional (IFNγ+TNFα+, IL2+IFNγ+, IL2+IFNγ+TNFα+) CD4+ T cells and increased frequencies of IFNγ+CD3-CD7+ NK cells compared to asymptomatic cases, or controls, after stimulation with the pdm09 virus. Taken together, virus specific and functionally distinct T and NK cell populations may serve as cellular immune correlates of clinical outcomes of pandemic influenza disease in pregnant women. Our results may provide information important for future universal influenza vaccine design.

Antiviral Treatment among Hepatitis B Virus-Infected Pregnant Women—New York City and Michigan, 2013–2015

BackgroundIndividuals with chronic hepatitis B virus (HBV) infection are at increased risk for cirrhosis and hepatocellular carcinoma. Chronic HBV infection develops in 90% of persons infected at birth. Although postexposure prophylaxis (PEP), consisting of hepatitis B vaccine and immune globulin at birth, and completion of the three-dose vaccine series prevents up to 95% of perinatal HBV infections; however, breakthrough infections can occur, especially among infants born to women with high viral loads (VLs). Maternal antiviral treatment during pregnancy can reduce perinatal HBV transmission by 70% above the effect of infant PEP alone. We assessed factors associated with maternal antiviral treatment in a cohort of HBV-infected pregnant women with high VL.MethodsDuring 2013–2015, the CDC-funded Supplemental Perinatal Hepatitis B Prevention Program collected information from interviews and medical charts of HBV-infected pregnant women in two sites. We assessed the association of demographic and clinical factors with maternal treatment in women with high VL (>200,000 IU/mL), considering statistical significance at P < 0.05.ResultsAmong 1,521 women with maternal treatment and VL data, 151 (10%) had high VL. Among these 151 women, 66 (44%) received antiviral treatment (Table), all of whom were of Asian/Pacific Island race. None of the seven women of other races were treated (P = 0.02). Fifty-nine women (48%) receiving Medicaid were treated compared with six women (24%) who had private insurance (P = 0.04).ConclusionMother’s race, country of birth, and insurance status were significantly associated with treatment in women with high VL. Because most women with high VL did not receive antiviral treatment during pregnancy, opportunities to reduce perinatal HBV transmission exist. Table. Association between characteristics of pregnant women with high viral load and HBV treatment status.CharacteristicTreated (n = 66)Not treated (n = 85) P-valueAge in years, median (IQR)29.5 (26.8, 33.1)31.0 (27.7, 34.7)0.09Mother’s race, n (%)0.02Asian/Pacific Islander66 (46%)78 (54%)Other07 (100%)Country of birth0.005China61 (49%)63 (51%)Other5 (19%)22 (81%)Mother’s insurance0.04Medicaid59 (48%)65 (52%)Private6 (24%)19 (76%)Other1 (50%)1 (50%)Disclosures All authors: No reported disclosures.

High prevalence of asymptomatic sexually transmitted infections among human immunodeficiency virus-infected pregnant women in a low-income South African community.

There is a lack of evidence on the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) among HIV-infected pregnant women in South Africa. We conducted a cross-sectional analysis of HIV-infected pregnant women in two healthcare facilities in a South African township to determine the prevalence of CT, NG and TV. HIV-infected pregnant women were recruited during the first antenatal care visit for their current pregnancy and requested to self-collect vulvovaginal swab specimens. Specimens were tested for CT, NG and TV using the Xpert® assay (Cepheid, Sunnyvale, CA). Of 247 tested for CT, NG and TV, 47.8% tested positive for at least one organism; CT = 36.8%, TV = 23.9%, NG = 6.9%. Forty three (17.4%) had multiple infections, of which 42 included CT as one of the infecting organisms. Of the 118 participants who tested positive for at least one sexually transmitted infection (STI), 23.7% reported STI-like symptoms. Among women who tested positive for CT, 29.7% reported symptoms while 47.1 and 27.1% of those who tested positive for NG and TV, respectively, reported symptoms. The high STI prevalence coupled with the low symptom prevalence among infected individuals justifies the use of diagnostic screening approaches rather than syndromic management of STIs in this setting.

Point-of-care screening for hepatitis B virus infection in pregnant women at an antenatal clinic: A South African experience.

Background & aimsElimination of HIV and syphilis mother-to-child transmission (MTCT) has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC) test and implementing interventions to prevent HBV MTCT.MethodsIn this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF) treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.ResultsOf 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test). Six women tested positive for HBsAg (4.5%; 95% CI 0.99%–8.01%), all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4) had undetectable levels of HBV DNA when tested at the two time points.ConclusionWe found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.

Appraisal of the Preparedness of Midwives and Nurses in Bahrain to Conduct Early Screening for Zika Virus Infection in Pregnant Women.

To appraise the awareness and knowledge levels of midwives and nurses concerning early screening for Zika virus (ZIKV) infection among pregnant women attending health care facilities in Bahrain. This was a cross-sectional, purposely chosen study of Bahraini and expatriate midwives, nurses, and supervisors employed in gynecology/obstetrics and labor wards of Salmanya hospital, a maternity hospital, 4 private hospitals, and health centers in Bahrain. The chosen individuals were invited to participate in a survey on awareness and knowledge of early screening for ZIKV infection. Of 266 midwives and nurses employed in the study sites, 170 (64%) consented to participate in the study. Of those who agreed to participate, 76 were midwives and 94 were nurses. Admittedly, 39% of midwives and nurses were unaware of ZIKV infection. The grand mean knowledge score in the study was 39%. Expatriate midwives and nurses scored better than did Bahrainis (P<0.001). The grand mean knowledge scores of evening and night shift duty participants were significantly higher than those of the day duty participants. The awareness and knowledge scores of midwives and nurses concerning ZIKV infection were inadequate, which supported our hypothesis. By harnessing modern technology and support systems, lifelong learning can be used as a means to enhance preparedness for public health crises such as ZIKV. (Disaster Med Public Health Preparedness. 2018;12:7-13).

Zika Virus Infection in Pregnant Women and Microcephaly.

From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damage to the central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection's devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR) with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKV urine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.

Monoclonal Antibodies Show Promise as the Key to Zika Virus Diagnostics.

Before 2016, little was known about Zika virus and its potentially devastating effects on fetuses and newborns. It quickly grew into a worldwide epidemic of crippling proportions. Flaviviruses are predominantly transmitted by a mosquito vector, but Zika virus is the first Flavivirus to demonstrate sexual transmission. Although largely asymptomatic, infection during a woman's pregnancy can cause fetal abnormalities such as microcephaly and intracranial calcifications, leading to serious developmental issues in newborns. There remains no vaccine or definitive treatment. However, identification of Zika virus is paramount, particularly because the strain thought to cause fetal abnormalities has spread in Central and South America and the Caribbean. Diagnosis of Zika virus infection in pregnant women prompts frequent and routine monitoring of the developing fetus and consideration of pregnancy termination. Because of the potential …

Social and Medical Aspects of the Association HIV and Herpes Virus Infection in Pregnant Women

The objective: to evaluate the social and health aspects of the association of HIV and herpes infections (GVI) in pregnant women.&#x0D; Patients and methods. Clinical and statistical analysis of 1177 individual cards of pregnant women with HIV for 5 years. The control group consisted of 200 pregnant women with physiological pregnancy.&#x0D; Results. Analysis of individual cards of pregnant women with HIV found insufficient to TORCH-infection survey (74,7%). The frequency of herpes infections in HIV-infected patients was 42,3%. The most common laboratory revealed HSV1/2 – 41,9%, CMV – 22,4% and mixed infection (both HSV1/2 and CMV) – 28,1%, other types of AIT is quite rare. At 8,5% of pregnant women stated primary infection herpes viruses, 27,2% – the reactivation of infection. HIV infection is often associated with other infections: hepatitis, fungal infections, toxoplasmosis, papillomavirus infections, respiratory infections, infections of the genitourinary system. Fixed low social status of HIV-infected women with AIT, the presence of harmful habits, a high frequency of co-infections and low compliance to treatment, are additional factors of perinatal risk. History data indicate a high rate of abortions and missed abortion in women with HIV infection and GVI. Going the way of HIV infection with parenteral on sex strengthens the role of herpes virus infection as a cofactor transition from HIV to AIDS, and the development of perinatal complications. The current pregnancy burdened with 84,3% of women: high incidence of placental insufficiency (41,3%), the threat of miscarriage and preterm labor, fetal distress. Maternal mortality in 5 years was noted in 2 cases (0,1‰), both women were GVI, perinatal – in 12 cases, 8 (21,5‰) of them women with AIT. 12,1% of children were born in a state of severe asphyxia, malnutrition with 31,3%, from 3,8% of the children at the end of 1st day intrauterine diagnosed pneumonia.&#x0D; Conclusions. The high frequency of co-infection of HIV and herpes viruses, joining other infections and comorbidity in these women, their low social adaptation, and susceptibility to treatment, the negative impact of herpes infection in the course of HIV infection, the condition of women during pregnancy, the fetus and the newborn, which requires individual approach to the management of women based on established medical and social aspects of the problem.

Prevalence of hepatitis B in pregnant women and management of babies born to Hepatitis B positive mother: a criterion based clinical audit

Introductions: This study aims at identifying the prevalence of Hepatitis B virus infection in pregnant women and adherence to the management of the newborns of these women as per the international guidelines.Methods: This was a cross sectional study conducted at Patan Hospital from January 1, 2008 to December 30, 2014. Prevalence of HBsAg in pregnant women in Patan Hospital and management of babies born to these women, the immunization status, breast feeding status and follow up advice for the babies were studied. These data were analyzed to see whether we were following international guidelines for preventing mother to child transmission of hepatitis B infection.Results: There were total of 58,917 deliveries and 59,438 births during the seven-year study period. During this period, total 148 cases of pregnant ladies with HBsAg positive status were recorded. The prevalence of HBsAg positive case was 0.25% or 1 in every 398 deliveries. Fifty-four babies (87%) received hepatitis B vaccine (HBV) and hepatitis B immunoglobulin (HBIG) within 12 hours of birth. Eight babies (22%) failed to receive HBV and HBIG within 12 hours of birth. Fifty-eight (96%) babies were breastfed after birth. Mother’s HBsAg positive status was not the reason for formula feeding in any of the babies. Follow up HBsAg status was not advised in any of the babies.Conclusions: Patan Hospital seems to be following most of the guidelines in the management of HBV infection in pregnant women, except for checking the HBsAg status of their babies at 9-18 months of age.Journal of Patan Academy of Health Sciences. 2016 Dec;3(2):23-27

Features of chronic hepatitis C course in pregnant women

Aim. To study features of the course of chronic hepatitis C virus infection in pregnant women and its effect on pregnancy.Methods. The study included 111 pregnant women: 67 with chronic hepatitis C and 44 healthy women. The mean age was 28 years. The number of pregnancies among examined women ranged from 1 to 8. All pregnant women had no concomitant therapeutic pathology and various addictions (alcohol, nicotine, drugs). The viral load in pregnant women with chronic hepatitis C ranged from 3.18×102 to 2.4×107 IU/mL.Results. Alanine aminotransferase and bilirubin levels in the group of chronic hepatitis C and in healthy pregnant women did not exceed the normal range and were not statistically different from each other. In repeated pregnancies viral load of hepatitis C virus was lower, compared with the first pregnancy: median [25%; 75%] = 5.202 [4.079; 6.364] and 6.658 [5.708; 7.380], respectively (p106 IU/mL). At the same time threatened miscarriage, intrauterine hypoxia and preeclampsia were registered more often.Conclusion. In the first pregnancy the viral load is higher than in repeated pregnancies; pregnancy in women with chronic hepatitis C without concomitant diseases does not cause activation of the inflammatory process in the liver; in pregnant women with chronic hepatitis C, especially at higher viral loads, medical history remarkable for obstetric diseases are more likely detected.

Telbivudine treatment of hepatitis B virus-infected pregnant women at different gestational stages for the prevention of mother-to-child transmission: Outcomes of telbivudine treatment during pregnancy.

This prospective study evaluated the viability of telbivudine for blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV) infection.Pregnant women positive for the hepatitis B surface antigen began telbivudine treatment before 14 weeks of gestation (i.e., early), between 14 and 28 weeks of gestation (late), or not at all (control). In the late-treatment group, 55 women terminated telbivudine therapy within puerperium. All neonates underwent routine hepatitis B immunoglobulin plus vaccination. Mothers and infants were followed for 7 months after birth.Pregnancy outcomes were similar among the 3 groups. HBV MTCT rates in the early and late treatment and control groups were 0, 0, and 4.69%, respectively. The rates of infant vaccination success among the 3 groups were similar, as were neonatal outcomes including birth weights, asphyxia, hyperbilirubinemia, Apgar score, birth defects, and weight and height at 7 months. Puerperal discontinuation of telbivudine did not increase the alanine transaminase value at 7 months after birth, but increased serum HBV DNA levels, and rates of positive hepatitis Be-antigen.Telbivudine treatment in HBV-infected pregnant women was associated with lower serum HBV DNA levels and reduced rates of HBV MTCT; there were no associated changes in pregnancy or neonatal outcomes at birth or 7 months after birth, or in the rate of infant vaccination success. Puerperal drug withdrawal after short-term antiviral therapy will not influence hepatic function, but may increase virus replication.