Prevalence of Cytomegalovirus infection among pregnant women with cord blood examination
Keywords:Cytomegalovirus Infections, Fetal Blood, Polymerase Chain Reaction, ELISA, IgG avidity
Objective: This study aimed at determining the prevalence of CMV infection among pregnant women at the end of pregnancy and CMV transmission to their newborns.
Methods: This is cross sectional study, 213 pregnant women at delivery and their newborn babies from the Obstetrics and Gynecology Hospital in Duhok /Iraq were enrolled. A questionnaire was prepared to be answered by participants, including age, place of residence, educational level, and obstetric history as number of births, any bad obstetric history such as abortion, still birth, intrauterine growth retardation, congenital anomalies after birth.3-5 ml of blood was drawn from each woman and examined by ELISA kit to check for the presence of Anti CMV IgM, IgG, then IgG avidity test for those with positive (IgG and IgM). Samples of cord blood were collected from newborns after birth and checked for the presence of CMV IgM by ELISA and CMV –DNA by conventional PCR using specific primers to diagnose congenital infection and determine the rate of viral transmission from infected women.
Results: Serological examinations showed that 212 (99.5%) participants were CMV-IgG positive, 15 (7%) were positive for anti-CMV IgM and IgG antibodies, IgG avidity test for 15 women were of high avidity (>89%) which indicated non primary infections. Cord blood of newborns of those 15 women with positive IgG and IgM tested negative for Anti CMV IgM by ELISA and no CMV-DNA was detected by PCR, which revealed no transmission from those pregnant to their newborns.
Conclusion: This study demonstrated high prevalence of CMV among examined pregnant women in Duhok city which makes them prone to non-primary infection. IgG avidity test is of high efficacy to interpret the detection of IgG and IgM together in pregnant women. Cord blood examination for the existence of CMV-IgM and CMV-DNA after delivery could exclude congenital infection.
Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol. 2010;20(4):202–13.
Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. 2007;17(4):253–76.
Lanzieri TM, Dollard SC, Bialek SR, Grosse SD. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis. 2014; 22:44–8.
Stagno S, Pass RF, Alford CA. Perinatal infections and maldevelopment. In: Bloom AD, James LS, eds. The fetus and the newborn. New York: Alan R. Liss, 1981; 31–50.
Demmler GJ. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis. 1991; 13:315–29.
Fowler KB. Congenital cytomegalovirus infection: audiologic outcome. Clin Infect Dis. 2013;57: S182–4.
Rivera LB, Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF. Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection. Pediatrics. 2002; 110:762–7.
Wagner N, Kagan KO, Haen S, Schmidt S, Yerlikaya G, Maden Z, Jahn G, Hamprecht K. Effective management and intrauterine treatment of congenital cytomegalovirus infection: review article and case series. J Matern Fetal Neonatal Med. 2014 Jan;27(2):209-14.
Leruez-Ville M, Ghout I, Bussières L, Stirnemann J, Magny JF, Couderc S, Salomon LJ, Guilleminot T, Aegerter P, Benoist G, Winer N, Picone O, Jacquemard F, Ville Y. In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicenter, open-label, phase II study. Am J Obstet Gynecol. 2016 Oct;215(4):462.e1-462.e10.
Johnson J, Anderson B: Screening, prevention, and treatment of congenital cytomegalovirus. Obstet Gynecol Clin North Am. 2014;41(4):593–9. 10.1016/j.ogc.2014.08.005
Lazzarotto T, Ripalti A, Bergamini G, Battista MC, Spezzacatena P, Campanini F, Pradelli P, Varani S, Gabrielli L, Maine GT, Landini MP. Development of a new cytomegalovirus (CMV) immunoglobulin M (IgM) immunoblot for detection of CMV-specific IgM. J Clin Microbiol. 1998 Nov;36(11):3337-41.
Cytomegalovirus (CMV) Antibodies, IgM and IgG, Serum. Mayo Clinic Laboratories. Available online at https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/62067. Accessed on 11/3/18.
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
Hazell SL. Clinical utility of avidity assays. Expert Opin. Med. Diagn. 2007;1:511–519. 10.1517/17530059.1.4.511.
Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin Microbiol Rev. 2002 Oct;15(4):680-715.
Chakravarti A, Kashyap B, Wadhwa A. Relationship of IgG avidity index and IgM levels for the differential diagnosis of primary from recurrent cytomegalovirus infections. Iran J Allergy Asthma Immunol. 2007 Dec;6(4):197-201.
Prince HE, Lapé-Nixon M, Novak-Weekley SM. 2014. Performance of a cytomegalovirus IgG enzyme immunoassay kit modified to measure avidity. Clin. Vaccine Immunol. 2014 Jun;21(6):808-12.
Kim DJ, Kim SJ, Park J, Choi GS, Lee S, Kwon CD, Ki C, Joh J. Realtime PCR assay compared with antigenemia assay for detecting cytomegalovirus infection in kidney transplant recipients. Transplant. Proc. 2007;39(5):1458–1460.
Noorbakhsh S, Farhadi M, Haghighi F, Minaeian S, Hasanabad MH. Neonatal screening
for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards. Iran J
Microbiol. 2020 Jun;12(3):198-203.
Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol. 2018 Apr;42(3):149-154.
Ross SA, Fowler KB, Ashrith G, Stagno S, Britt WJ, Pass RF, Boppana SB. Hearing loss in children with congenital cytomegalovirus infection born to mothers with preexisting immunity. J Pediatr. 2006 Mar;148(3):332-6.
Zuhair M, Smit S, Willis G, Jabbar F, Smith C, Devleesschauwer B, Griffiths P. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev. Med. Virol.2019; Vol. 29(3):e2034-.
Almishaal AA () Knowledge of cytomegalovirus infection among women in Saudi Arabia: A cross-sectional study. PLOS ONE. 2022;17(9): e0274863.
Abbas M D and Egbe S . Seroprevalence of CMV in Women with Bad Obstetric History in Babil/Iraq. Iraqi J Pharm Sci.2021; Vol.30(2).
Aljumaili Z, Alsamarai A, Najem W.Cytomegalovirus seroprevalence in women with bad obstetric history in, Iraq. Kirkuk Journal of Infection and Public Health.2014; Volume 7, Issue 4,Pages 277-288.
Ali K.The Sero-Prevalence of Cytomegalovirus Infection among Women with Abortion and Intrauterine Death in Erbil City Kurdistan Region. Diyala Journal of Medicine.2020; 77 Vol.18.Issue 1
Ayla SO, ževki CE, Aye CI, Sibel S, Serpil UN, Nuri D . Screening of cytomegalovirus seroprevalence among pregnant women in Ankara, Turkey: A controversy in prenatal care. African Journal of Microbiology Research. 2011; 9;5(29):5304-7.
Lachmann R, Loenenbach A, Waterboer T, Brenner N, Pawlita M, Michel A.).Cytomegalovirus (CMV) seroprevalence in the adult population of Germany. PLOS ONE. 2018; 13(7): e0200267
Wizman S, Lamarre V, Coic L, Kakkar F, Le Meur JB, Rousseau C, Boucher M, Tapiero B. Awareness of cytomegalovirus and risk factors for susceptibility among pregnant women, in Montreal, Canada. BMC Pregnancy Childbirth. 2016; Mar 15;16:54.
Alvarado-esquivel, c., Terrones-saldivar, m., Hernandez-tinoco, j., Munoz-terrones, m., Gallegos-gonzalez, r., Sanchez-anguiano, l. Seroepidemiology of Cytomegalovirus Infection in Pregnant Women in the Central Mexican City of Aguascalientes. Journal of Clinical Medicine Research, North America.2018; 10, feb.. Available at: <https://www.jocmr.org/index.php/JOCMR/article/view/3358>.
Gorun F, Motoi S, Malita D, Navolan DB, Nemescu D, Olariu TR, Craina M, Vilibic-Cavlek T, Ciohat I, Boda D, Dobrescu A. Cytomegalovirus seroprevalence in pregnant women in the western region of Romania: A large-scale study. Exp Ther Med. 2020 Sep;20(3):2439-2443.
Falahi, S., Ravanshad, M., Koohi, A.K., Karimi, A.M. Short com-munication: seroprevalence of CMV in women’s with spontaneous abortion in kowsar hospital, Ilam during 2007—2008. Modares J Med Sci Pathobiol. 2010; 12:39—43. 7.
Turbadkar, D., Mathur, M., Rele, M. Seroprevalence of TORCH infection in bad obstetric history. Indian J Med Microbiol. 2003; 21:108—11, 2003.
Stagno S, Tinker M K, Elrod C, Fuccillo D A, Cloud G, O'Beirne A J..Immunoglobulin M antibodies detected by enzyme-linked immunosorbent assay and radioimmunoassay in the diagnosis of cytomegalovirus infections in pregnant women and newborn infants. Journal of Clinical Microbiology. 1985;Vol. 21, No. 6 .
Mussi-Pinhata M M, Yamamoto A Y.Natural History of Congenital Cytomegalovirus Infection in Highly Seropositive Populations, The Journal of Infectious Diseases.2020; V 221, Issue 1, 15 Pages S15–S22.
Abdullahi Nasir I, Babayo A, Shehu MS. Clinical Significance of IgG Avidity Testing and Other Considerations in the Diagnosis of Congenital Cytomegalovirus Infection: A Review Update. Med Sci (Basel). 2016 Mar; 8;4(1):5.
Cytomegalovirus (CMV) and Congenital CMV Infection. [(accessed on 30 April 2015)];2010 Available online: http://www.cdc.gov/cmv/index.html
Shin S, Roh EY, Oh S, Song EY, Kim EC, Yoon JH. Excluding Anti-cytomegalovirus Immunoglobulin M-Positive Cord Blood Units Has a Minimal Impact on the Korean Public Cord Blood Bank Inventory. Cell Transplantation. 2017;26(1):63-70.
Al-Awadhi R, Al-Harmi J, Alfadhli S. Prevalence of cytomegalovirus DNA in cord blood and voided urine obtained from pregnant women at the end of pregnancy. Med Princ Pract. 2013;22(2):194-9.
Chiopris, G.; Veronese, P.; Cusenza, F.; Procaccianti, M.; Perrone, S.; Daccò, V.; Colombo, C.; Esposito, S. Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment. Microorganisms. 2020, 8, 1516.
How to Cite
Copyright (c) 2023 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.