Detection of Viral Deoxyribonucleic Acid in Amniotic Fluid: Association with Fetal Malformation and Pregnancy Abnormalities

Abstract

Objective: To first test the hypothesis that the presence of viral nucleic acid in amniotic fluid (AF) is associated with an abnormal pregnancy outcome, and second, to determine if the overall rate of polymerase chain reaction (PCR) positivity and the distribution of virus types vary geographically. Study Design: Cytomegalovirus (CMV), parvovirus B19, adenovirus, enterovirus, herpes simplex virus, Epstein-Barr virus, and respiratory syncytial virus nucleic acids were sought in 423 AF samples obtained for clinical indications: 284 from the East Coast (EC) and 139 from the Midwest (MW). Results: Gestational age at sampling was 19.1 weeks for EC and 20.1 weeks for MW. 13.5% of karyotypically normal singleton pregnancies (57/423) had a positive AF PCR. 11% of AF PCR from the EC while 18% of AF PCR from the MW were positive (p = 0.06). The most commonly detected viruses were adenovirus (77%), enterovirus (12%), and CMV and parvovirus B19 (5% each). Twenty-four percent of sonographically abnormal pregnancies (33/136) had a positive AF PCR compared to only 8.4% (24/287) of normal pregnancies (p < 0.001). Conclusion: A positive AF PCR is associated with an increased rate of fetal structural malformations, intrauterine growth restriction, hydrops and other fetal abnormalities. There were no significant geographic differences in the incidence of AF viral PCR positivity.

Adenovirus DNA in Guthrie cards from children who develop acute lymphoblastic leukaemia (ALL)

“…Of 1187 unique amniocentesis samples analysed in four separate studies of sonographically normal pregnancies, more than 1 in 20 (5.4%) contained adenoviral DNA ( Van den Veyver et al, 1998;Wenstrom et al, 1998;Baschat et al, 2003;Reddy et al, 2005). Remarkably, subsequent studies have detected no increased morbidity in infants following prenatal infection with adenovirus, as determined by PCR of amniocentesis samples (Miller et al, 2009), suggesting that prenatal infection, similar to postnatal infection, with species C adenoviruses is largely asymptomatic.…”

Adenovirus DNA is detected at increased frequency in Guthrie cards from children who develop acute lymphoblastic leukaemia

“…In addition to being a likely fetal pathogen (Towbin et al, 1994;Van den Veyver et al, 1998;Oyer et al, 2000;Baschat et al, 2003;Reddy et al, 2005), adenovirus DNA is also detected in the amniotic fluid from apparently normal pregnancies. Of 1187 unique samples in four large studies, 64 (5.4%) contained adenoviral DNA ( Van den Veyver et al, 1998;Wenstrom et al, 1998;Baschat et al, 2003;Reddy et al, 2005), which compares favourably with 6% adenovirus DNA-positive samples among the normal controls in the present study (Table 1). And, as is the case with children infected post-natally, adenoviral DNA is retained in latently infected T lymphocytes for years following primary infection (Garnett et al, 2002).…”

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

“…Other studies have identified that the sexually transmitted pathogens Chlamydia trachomatis and Neisseria gonorrhoeae, along with the uropathogen E. coli and yeast Candida spp., are also infrequently associated with chorioamnionitis (122,(125)(126)(127)(128). Viral etiologies of chorioamnionitis include adenovirus, cytomegalovirus, enterovirus, and, less frequently, respiratory syncytial virus and Epstein-Barr virus (129)(130)(131)(132). Of the microorganisms associated with chorioamnionitis, the human Ureaplasma spp.…”