scholarly journals Screening for Cytomegalovirus during Pregnancy

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Stuart P. Adler
Keyword(s):  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Cmv Infection ◽  
Blood Samples ◽  
High Risk Women ◽  
Effective Interventions ◽  
Fetal Infection ◽  
Recent Developments ◽  
Serologic Screening

The epidemiology and pathogenesis of CMV infections among pregnant women have been intensely studied over the last three decades. This paper highlights recent developments that make either universal or limited serologic screening for CMV during pregnancy potentially attractive. The developments include an understanding of the pathogenesis of CMV infections, a knowledge of high-risk women, the availability of accurate methods for the serologic diagnosis of a primary CMV infection using either single or serial blood samples, accurate methods for the diagnosis of fetal infection via amniotic fluid, sensitive fetal and placental indicators for neonatal outcomes, and the availability of potentially effective interventions.

Impact of the Israeli Ministry of Health Cytomegalovirus Guidelines on the Local Pregnancy Outcome

2020 ◽  
pp. 1-6
Author(s):  
Marina Pekar-Zlotin ◽  
Anat Alufi Naim ◽  
Perry Eliassi Revivo ◽  
Nadav Kugler ◽  
Yaakov Melcer ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Telephone Survey ◽  
Pregnancy Termination ◽  
Maternal Serum ◽  
Cmv Infection ◽  
Ministry Of Health ◽  
Newborn Outcomes ◽  
Fetal Infection ◽  
Postnatal Outcome

<b><i>Objective:</i></b> In 2011, the Israeli Ministry of Health (MOH) published standard guidelines for the follow-up of pregnant women infected by CMV, recommending that amniocentesis be performed in cases of maternal serum viral seroconversion or abnormal sonographic findings suggestive of CMV, in order to prove fetal infection before electing for pregnancy termination. <b><i>Methods:</i></b> A retrospective cohort study was performed, describing 448 pregnant women from 2006 to 2017. We collected data from all women that elected to continue their pregnancies after seroconversion and also of those who chose to undergo pregnancy termination. Subsequently, a telephone survey was then conducted to record outcomes of the newborns of women with CMV seroconversion during pregnancy. <b><i>Results:</i></b> 325 (73%) women chose to continue their pregnancy, while 123 (27%) opted for termination of pregnancy. We found that pregnancy termination due to CMV infection was reduced by 7%, from 72 cases (32%) to 51 cases (25%) after the implementation of the MOH guidelines in 2011. In addition, 182/305 (60%) of women responded to our telephone questionnaire regarding newborn outcomes. Of these women, 45/305 (14%) reported complications, and no correlation was found between the prenatal findings and postnatal outcome among those who have responded to our survey. <b><i>Conclusion:</i></b> Implementation of the new MOH guidelines has reduced the rate of pregnancy termination, without increasing the rate of neonatal complications in Israel with a similar outcome of complication rate as reported in the literature.

Amniotic fluid composition in pregnant women at high risk of preterm birth

2020 ◽  
Vol 8_2020 ◽  
pp. 82-87
Author(s):  
Khodzhaeva Z.S. Khodzhaeva ◽  
Gorina K.A. Gorina ◽  
Muminova K.T. Muminova ◽  
Ivanets T.Yu. Ivanets ◽  
Kessler Yu.V. Kessler ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Fluid Composition

Copper and Zinc in the Amniotic Fluid and Serum from High-Risk Pregnant Women

1979 ◽  
Vol 161 (3) ◽  
pp. 382-385 ◽  
Author(s):  
T. R. Shearer ◽  
E. W. Lis ◽  
K. S. Johnson ◽  
J. R. Johnson ◽  
G. H. Prescott
Keyword(s):  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Copper And Zinc

scholarly journals Development and Application of a PCR-Based Method Including an Internal Control for Diagnosis of Congenital Cytomegalovirus Infection

2000 ◽  
Vol 38 (1) ◽  
pp. 1-6
Author(s):  
Rachel N. Jones ◽  
M. Lynne Neale ◽  
Brian Beattie ◽  
Diana Westmoreland ◽  
Julie D. Fox
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Internal Control ◽  
Congenital Infection ◽  
Diagnostic Group ◽  
Urine Samples ◽  
Diagnostic Tools ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
Developed World

ABSTRACT Cytomegalovirus (CMV) is the most common cause of congenital infection in the developed world. We have designed and evaluated an assay that includes an internal control for amplification and detection of CMV DNA in amniotic fluid and neonatal urine samples. We present data on the use of this assay in the diagnosis of congenital CMV infection. A total of 145 amniotic and fetal fluid samples were examined by this assay; 83 were from healthy pregnant women and 62 were from women who were being investigated because of concerns over the pregnancy (diagnostic group). CMV DNA was detected in three amniotic fluid samples from the diagnostic group but was not detected in any samples taken from healthy pregnant women. Thirty-nine urine samples were obtained from 19 neonates with suspected congenital infection; CMV DNA was detected in urine from 6 of these patients. The assay provides useful information about CMV infection in the fetus and the neonate; when used in conjunction with other diagnostic tools it will enable mothers and obstetricians to make informed decisions about the management of pregnancies complicated by CMV infection.

scholarly journals Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women

2021 ◽  
Author(s):  
A. Lapolla ◽  
M. G. Dalfrà ◽  
S. Burlina
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Neonatal Morbidity ◽  
Published Data ◽  
International Debate ◽  
Lactating Women ◽  
High Risk Women ◽  
Pregnancy And Lactation ◽  
Potential Benefits ◽  
Diabetes And Obesity

Abstract Aim The recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity. Methods Analysis of literature about vaccination against COVID-19 infection in pregnancy. Results The main health organizations and international scientific societies, emphasize that—although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking—vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn. Conclusions We urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.

High-Dose Cytomegalovirus (CMV) Hyperimmune Globulin and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary CMV Infection

2019 ◽  
Vol 71 (6) ◽  
pp. 1491-1498 ◽  
Author(s):  
Giovanni Nigro ◽  
Stuart P Adler ◽  
Stefania Lasorella ◽  
Giulia Iapadre ◽  
Maria Maresca ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Odds Ratio ◽  
Fold Increase ◽  
High Dose ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Fetal Infection ◽  
Hyperimmune Globulin ◽  
Infant Outcome

Abstract Background After primary maternal cytomegalovirus (CMV) infection during pregnancy, infants are at risk for disease. Methods Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with primary infection. These women were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range, 1–8 years). One hundred fifty-seven women were treated with an average of 2 doses (range, 1–6 doses) of high-dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae; 31 covariates were tested. Results Four factors predicted fetal infection: a 1.8-fold increase (30% vs 56%) in the rate of congenital infection without HIG (adjusted odds ratio [AOR], 5.2; P &lt; .0001), a 1.8-fold increase (32% vs 56%) associated with maternal viral DNAemia prior to HIG administration (AOR, 3.0; P = .002), abnormal ultrasounds (AOR, 59; P = .0002), and diagnosis of maternal infection by seroconversion rather than avidity (AOR, 3.3; P = .007). Lack of HIG and abnormal ultrasounds also predicted symptoms (P = .001). Long-term sequelae were predicted by not receiving HIG (AOR, 13.2; P = .001), maternal infection in early gestation (odds ratio [OR], 0.9; P = .017), and abnormal ultrasounds (OR, 7.6; P &lt; .003). Prevalence and copy/number of DNAemia declined after HIG. Conclusions Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease and is associated with the resolution of DNAemia.

Therapeutics to prevent congenital cytomegalovirus during pregnancy: what is available now and in the future?

2015 ◽  
Vol 36 (4) ◽  
pp. 156 ◽  
Author(s):  
Stuart T Hamilton ◽  
Corina Hutterer ◽  
Manfred Marschall
Keyword(s):  
Pregnant Women ◽  
Developed Countries ◽  
Fetal Malformation ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Fetal Infection ◽  
Congenital Cmv Infection ◽  
Social Importance ◽  
Cmv Disease ◽  
Congenital Cmv

Human cytomegalovirus (CMV) is the leading non-genetic cause of fetal malformation in developed countries. Congenital CMV infection can cause serious clinical sequelae, and in severe cases result in fetal or neonatal death. Despite the clinical and social importance of congenital CMV there is currently no standardised management strategy to prevent or treat maternal/fetal CMV infection during pregnancy and no evidence-based therapeutic for prenatally diagnosed CMV infection or disease. For pregnant women with a primary CMV infection during pregnancy, standard medical practise remains to offer no treatment at all or the option to terminate pregnancy. If intervention is requested, pregnant women may be offered a narrow range of medical therapies with limited evidence for efficacy and some with high risks of toxicity. However, there are several experimental and novel anti-CMV therapeutics currently being investigated that may provide a safe and effective therapeutic for use during pregnancy to prevent both fetal infection and reduce the risk of congenital CMV disease developing in the fetus once infected in utero.

scholarly journals Maternal-Fetal Transfer and Amniotic Fluid Accumulation of Nucleoside Analogue Reverse Transcriptase Inhibitors in Human Immunodeficiency Virus-Infected Pregnant Women

2004 ◽  
Vol 48 (11) ◽  
pp. 4332-4336 ◽  
Author(s):  
Hélène Chappuy ◽  
Jean-Marc Tréluyer ◽  
Vincent Jullien ◽  
Jérôme Dimet ◽  
Elisabeth Rey ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Nucleoside Analogue ◽  
Placental Transfer ◽  
Plasma Samples ◽  
Reverse Transcriptase Inhibitors ◽  
Blood Samples ◽  
Immunodeficiency Virus ◽  
Glucuronide Metabolite

ABSTRACT This study was performed to investigate placental transfer of nucleoside analogue reverse transcriptase inhibitors (NRTIs) and their concentrations in amniotic fluid when given to human immunodeficiency virus (HIV)-infected pregnant women. A total of 100 HIV type 1-infected mothers receiving antiretroviral therapy, including one or more NRTIs, for clinical indications at the time of delivery were enrolled. Maternal blood samples and amniotic fluid were obtained during delivery or cesarean section, and paired cord blood samples were obtained by venipuncture immediately after delivery. Drug concentrations were measured by using high-performance liquid chromatography. A significant relationship between concentrations in maternal and cord plasma samples was found for zidovudine, lamivudine, stavudine, and didanosine. The ratio between the concentrations in cord and maternal plasma samples (R) was high for zidovudine (R = 1.22), its glucuronide metabolite (3′-azido-3′-deoxythymidine-β-d-glucuronide) (R = 1.01), stavudine (R = 1.32), lamivudine (R = 0.93), and abacavir (R = 1.03) and was low for didanosine (R = 0.38). The ratio between the concentrations in amniotic fluid and cord plasma samples was high for zidovudine (R = 2.24), its glucuronide metabolite (R = 2.83), stavudine (R = 4.87), and lamivudine (R = 3.99) and was lower for didanosine (R = 1.14). These findings indicate that most NRTIs cross the placenta by simple diffusion and are concentrated in the amniotic fluid, probably through fetal urinary excretion. The efficacy or toxicity of NRTIs may vary according to placental transfer.

scholarly journals The Burden of Hyperglycemia First Detected in Pregnancy Among Indonesian Women

2020 ◽  
Author(s):  
Najmiatul Fitria ◽  
Ivan Surya Pradipta ◽  
Bobby Indra Utama ◽  
Maarten Postma ◽  
Antoinette van Asselt ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Health ◽  
Pregnant Women ◽  
Fasting Blood Glucose ◽  
World Health ◽  
Oral Glucose ◽  
High Risk Women ◽  
Glucose Levels ◽  
Risk Of Death ◽  
In Pregnancy

Abstract OBJECTIVE: Despite improvements, Indonesian maternal health falls short of the Sustainable Development Goals. Using contemporary electronic healthcare records, this study explored the burden of Hyperglycemia First Detected in Pregnancy (HFDP) and its association with the determinants of maternal health in Indonesia. METHODS: Electronic Health Records data were extracted on high-risk pregnant women without pre-existing diabetes who were screened for HFDP between 2014 and 2015 at two West Sumatera hospitals. Screening consisted of an oral glucose tolerance test (OGTT), grouping women into Diabetes In Pregnancy (DIP, glucose 126 mg/dl), Gestational Diabetes Mellitus (GDM, glucose 92-125 mg/dl), or high-risk women without elevated glucose levels (glucose < 92 mg/dl); following the World Health Organization (WHO) standard. Maternal and neonatal outcomes, including mortality, were associated with the three diabetes statuses, using general and generalized linear models (depending on the type of outcome) adjusted for maternal age and parity. RESULT: 3536 pregnant women were screened, of which 722 (21%) had HFDP; 655 (19%) were classified as GDM and 67 (2%) as DIP. Women with HFDP did not have a significantly higher risk of death: OR 1.36 (95%-CI 0.71-2.62) for GDM and 0.90 (95%-CI 0.12-6.67) for DIP. We did observe a significantly lower neonatal death rate for children born of GDM women, with three deaths (1%) compared to 178 (6%) in high-risk normal FBG women (p-value < 0.01). This observation was not replicated when comparing DIP to normal FBG women (OR 0.58; 95%-CI 0.26-1.29). CONCLUSION: The observed lack of difference in pregnancy outcomes between HFDP and pregnant women with normal fasting blood glucose levels (at the time of screening) reflects the considerable residual risk of these women. Nevertheless, have and calls for closer monitoring of high-risk women irrespective of their OGTT results. Larger sample-sized studies are warranted to replicate findings with sufficient accuracy to detect possibly smaller, but meaningful differences.

scholarly journals The Presence of Mycotoxins in Human Amniotic Fluid

Toxins ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 409
Author(s):  
Karolina Gromadzka ◽  
Jakub Pankiewicz ◽  
Monika Beszterda ◽  
Magdalena Paczkowska ◽  
Beata Nowakowska ◽  
...  
Keyword(s):  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Prenatal Screening ◽  
Genetic Defects ◽  
Chromosomal Anomalies ◽  
Risk Characterization ◽  
Fusarium Mycotoxins ◽  
Human Amniotic Fluid ◽  
Toxic Metabolites

Mycotoxin exposure assessments through biomonitoring studies, based on the analysis of amniotic fluid, provides useful information about potential exposure of mothers and fetuses to ubiquitous toxic metabolites that are routinely found in food and the environment. In this study, amniotic fluid samples (n = 86) were collected via abdominal amniocentesis at 15–22 weeks of gestation from pregnant women with a high risk of chromosomal anomalies or genetic fetal defects detected during 1st trimester prenatal screening. These samples were analyzed for the presence of the most typical Aspergillus, Penicillium and Fusarium mycotoxins, with a focus on aflatoxins, ochratoxins and trichothecenes, using the LC-FLD/DAD method. The results showed that the toxin was present in over 75% of all the tested samples and in 73% of amniotic fluid samples from fetuses with genetic defects. The most frequently identified toxins were nivalenol (33.7%) ranging from <LOQ to 4037.6 ng/mL, and aflatoxins (31.4%), including aflatoxin G1, ranging from <LOQ to 0.4 ng/mL. Ochratoxin A and deoxynivalenol were identified in 26.7% and 27.9% of samples, respectively. Bearing in mind the above, the detection of mycotoxin levels in amniotic fluid is useful for the estimation of overall risk characterization with an attempt to link the occurrence of fetal abnormalities with exposure to mycotoxins in utero.

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