Our data demonstrate a relevant B19-associated risk of fetal death, which is largely confined to maternal B19 infection in the first 20 WG. Timely intrauterine transfusion of fetuses with severe hydrops fetalis reduces the risk of fetal death. Parvovirus B19-associated stillbirth without hydropic presentation is not a common finding.

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curred in 19 women and resulted in 17 full-term pregnancies. An increase in the levothyroxine dose was necessary during 17 pregnancies. The mean levothyroxine requirement increased by 47% during the first half of pregnancy. Given the importance of maternal euthyroidism for normal fetal cognitive development, the authors proposed that the women with hypothyroidism increase their levothyroxine dose by approximately 30% as soon as the pregnancy is confirmed. (N Engl J Med 2004;351:241).In some of the children in the study abstracted here, a high maternal TH level may have induced a catabolic state during fetal life leading to decreased birth weight. This may be the first evidence that maternally transferred TH in an euthyroid mother could have a direct toxic effect on fetal development. Maintenance of euthyroidism in a pregnant patient by increasing levels of TH replacement may not be as safe and simple as previously understood.In November 2001, ACOG published a practice bulletin on the clinical management guidelines for thyroid disease in pregnancy. This bulletin clearly outlines the physiological changes in thyroid function during pregnancy to indicate that TSH, free thyroxine (FT4), and free thyroxin index (FTI) do not change in pregnancy. In pregnant patients suspected of being hyperthyroid or hypothyroid, FT4 or FTI should be measured. The goal of management would be to maintain FT4 of the FTI in the high-normal range using the lowest possible dose of medication (Obstet Gynecol 2001;98:883).-RCC) ABSTRACTBetween one third and two thirds of pregnant women in different parts of the world are susceptible to human parvovirus B19 (B19) infection. Acute infection by B19 during pregnancy has been associated with fetal anemia, hydrops fetalis, nonhydropic intrauterine fetal death, and asymptomatic fetal infection.

This investigation was undertaken to provide detailed information on the epidemiology of human parvovirus B19 (B19) infection during pregnancy and childhood in the western part of Germany. Between 1997 and 2004, 40,517 sera from pregnant women aged 17-45 years and 6060 sera from children and young adults were tested for B19 IgG and IgM in our laboratory. In pregnant women, both the history of a 'specific' (OR 7.7, 95% CI 5.2-11.4) and a 'non-specific' rash (OR 3.3, 95% CI 1.5-7.1) was predictive for B19 IgM positivity. The B19 IgG prevalence was 69.2% (4097/5924) in a subgroup of asymptomatic pregnant women screened for B19 antibodies. In children, the age-specific IgG-positivity rate increased from 12.2% (66/541) at 2 years of age to 71.9% (396/551) in those older than 10 years. In conclusion, the prevalence of B19 IgG in pregnant women from the western part of Germany is higher then previously reported. Contact with children aged 3-10 years is a major risk factor for exposure to B19. Pregnant women with the history of a 'non-specific' rash should also be evaluated for acute B19 infection.

At the time of B19-induced hydrops, detection of B19 DNA in maternal blood had the best diagnostic sensitivity for identifying maternal B19 infection. However, given the long persistence of B19 DNAemia, supplementary measurement of VP1 IgG avidity and VP2 IgG ETS improves the precision of diagnosis and management of pregnant women affected by the B19 virus.