Association of Cytomegalo-Virus and Rubella Virus Infections in Pregnant Women with bad Obstetric History
Background: Bad obstetric history
(BOH) comprises of previous adverse fetal consequences in terms of two
or more successive spontaneous
abortions, early neonatal deaths, stillbirths, intrauterine fetal
deaths, intrauterine growth retardations and congenital anomalies. The
infections
which are caused by Rubella virus and CMV during pregnancy are often
associated with adverse fetus outcomes and reproductive failures. In the
Yemen context, the exact seroprevalence of these infections is not known
due to unavailability of baseline data.
Objective:The main aim of this study was to determine the correlation of the main viral TORCH infections (Rubella and CMV) during pregnancy among Yemeni females with BOH.
Methods:Two hundred- sixty-eight serum samples were collected from participants having BOH, attending Department of Obstetrics and Gynecology, Al-Sabian University hospital, Sana’a city during the period of September 2017 to September 2018. IgM antibodies for Rubella virus and CMV were detected by micro-capture ELISA tests.
Results:The common causes of BOH were abortion (52.6%), intrauterine fetal death (22%) followed by intrauterine growth retardation (10.4%). Fourteen (5.2%) of pregnant women were positive for CMV IgM antibodies, 10 (3.7%) for Rubella IgM antibodies and 4 (1.5%) for CMVRubella virus in combination; indicating recent infections. There was significant association between the positive results of anti-CMV IgM -anti- Rubella IgM with age group ≥ 36 years (OR=31,6.2 respectively). Also, there was a significant association between the positive results of anti-CMV IgM with congenital deformation (OR=10.2, p<0.001).
Conclusion: IgM antibody positivity was high for Rubella and CMV and there is a strong association of these agents with BOH. Thus, screening and early diagnosis for these pathogens in women can help in proper management of these cases to prevent fetus loss.
Keywords: TORCH; Bad obstetric history (BOH); CMV; Rubella virus; IgM; Sana’a; Yemen
Objective:The main aim of this study was to determine the correlation of the main viral TORCH infections (Rubella and CMV) during pregnancy among Yemeni females with BOH.
Methods:Two hundred- sixty-eight serum samples were collected from participants having BOH, attending Department of Obstetrics and Gynecology, Al-Sabian University hospital, Sana’a city during the period of September 2017 to September 2018. IgM antibodies for Rubella virus and CMV were detected by micro-capture ELISA tests.
Results:The common causes of BOH were abortion (52.6%), intrauterine fetal death (22%) followed by intrauterine growth retardation (10.4%). Fourteen (5.2%) of pregnant women were positive for CMV IgM antibodies, 10 (3.7%) for Rubella IgM antibodies and 4 (1.5%) for CMVRubella virus in combination; indicating recent infections. There was significant association between the positive results of anti-CMV IgM -anti- Rubella IgM with age group ≥ 36 years (OR=31,6.2 respectively). Also, there was a significant association between the positive results of anti-CMV IgM with congenital deformation (OR=10.2, p<0.001).
Conclusion: IgM antibody positivity was high for Rubella and CMV and there is a strong association of these agents with BOH. Thus, screening and early diagnosis for these pathogens in women can help in proper management of these cases to prevent fetus loss.
Keywords: TORCH; Bad obstetric history (BOH); CMV; Rubella virus; IgM; Sana’a; Yemen
Introduction
Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, stillbirth, early neonatal death, and/or congenital anomalies [1]. The causes of BOH may be genetic, hormonal, abnormal maternal immune response, and maternal infections [2].The prenatal and perinatal infections, falling under the designation of TORCH complex [3] (also known as STORCH, TORCHES, or the TORCH infections), are a medical acronym for a set of perinatal infections [4], i.e., infections that are passed from a pregnant woman to her fetus. The TORCH infections can lead to severe fetal anomalies or even fetal loss. They are a group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream trans placentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion [5]. Primary infections caused by TORCH-Toxoplasma gondii, Rubella virus, CMV and herpes simplex virus (HSV)-are the major causes of BOH [6]. These infections usually occur before the woman realizes that she is pregnant or seeks medical attention. The primary infection is likely to have a more important effect on fetus than recurrent infection and may cause congenital anomalies, spontaneous abortion, intrauterine fetal death, intrauterine growth retardation, prematurity, stillbirth, and live born infants with the evidence of disease [7]. Most of the TORCH infections cause mild maternal morbidity but have serious fetal consequences [8]. The ability of the fetus to resist infectious organisms is limited and the fetal immune system is unable to prevent the dissemination of infectious organisms to various tissues [9]. An attempt is being made in this work to find out the correlation of the main viral TORCH infections namely Rubella and Cytomegalovirus during pregnancy among Yemeni females with BOH in Sana’a city, Yemen.
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