Pre- and Periconceptional Primary Cytomegalovirus Infection: Risk of Vertical Transmission and Congenital Disease

Abstract

An estimated 6% to 8% women develop hypertension during pregnancy, which has been linked with asthma, through either the condition itself or treatment such as oral corticosteroids. Steroid use also has been linked with an increased risk of preeclampsia. This large population-based case-control study was planned to determine whether inhaled steroids increase the risk of either pregnancy-induced hypertension or preeclampsia in asthmatic women. Participants were 3505 women with asthma, 14-44 years of age, who had 4593 pregnancies in the years 1990-2000. As many as 10 control women at 30 or more weeks gestation were selected for each case. Sociodemographic factors were similar in the case and control groups.There were 302 cases of pregnancy-induced hypertension, representing 6.6% of the study population. They included 128 cases of gestational hypertension, 165 cases of preeclampsia, and 9 cases of eclampsia. More case women than controls were prescribed inhaled corticosteroids before and during pregnancy, and more were taking oral steroids. Case women who took more than 3 doses of a short-acting ␤ 2 agonist per week before pregnancy were at increased risk of pregnancy-induced hypertension, but this level of treatment during pregnancy correlated with a lower risk. Cases more often visited an emergency department for asthma. Using inhaled steroids while pregnant was not associated with the risk of either preeclampsia or pregnancy-induced hypertension. There was no dose-response relationship with inhaled steroids for either of these conditions. Oral steroids were, however, significantly associated with pregnancy-induced hypertension; the adjusted odds ratio was 1.57, and the 95% confidence interval was 1.02-2.41.This study failed to significantly relate the use of inhaled corticosteroids to either pregnancy-induced hypertension or preeclampsia in asthmatic women. These women should be encouraged to continue using inhaled steroids while pregnant to control their asthma. ABSTRACTThere is limited evidence that periodontitis is associated with preterm birth, but why it might induce inflammation and premature termination of pregnancy remains uncertain. The investigators evaluated periodontal status in 36 women at risk of miscarriage or preterm delivery. Amniocentesis was carried out at 15-20 weeks gestation, and a full-mouth periodontal examination was done at approximately the same time. The criterion for periodontitis was at least 1 site with a probing depth of 5 mm or greater in each quadrant. The 2 sites with the deepest pockets were chosen for microbial sampling of intraoral plaque. Vaginal smears also were obtained and cytokine levels estimated in amniotic fluid samples.Chronic periodontitis was diagnosed in 20% of women delivering within the normal period and in 83% of those who had a preterm delivery and an infant with low birth weight. All women with preterm gestations had regularly received dental care. Probing depths differed significantly in the preterm and full-term cases. In no case was the amniotic fluid infec...

A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome

“…[12][13][14][15][16][17][18][19][20] We report important data concerning the rate of maternal-fetal transmission before and during pregnancy and confirm that symptomatic congenital CMV infections are hardly observed if maternal infection occurs after 14 WG. We found far fewer maternal symptoms than previously reported (21% in our cohort vs 68-73.5% in Revello et al 17,21,22 and 60% in Nigro et al 22 ).…”

“…Each subject included had maternal primary CMV infection assessed by serology analysis and precise gestational dating. Subjects were classified in different subgroups according to the time of maternal infection: preconceptional (2 months to 3 weeks before the date of conception), periconceptional (3 weeks before to 3 weeks after the date of conception), or first (3-14 weeks of gestation [WG]), second (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) or third trimester of pregnancy (28 WG up to delivery). Subjects with imprecise date of maternal infection were excluded from the study.…”

The “Silent” Global Burden of Congenital Cytomegalovirus

“…Most recent studies report lower transmission rates in early pregnancy (in comparison to later gestation) (52)(53)(54)(55)(56)(57)(58), with maternal primary infection leading to infection in 30 to 35% (Fig. 2) of fetuses and nonprimary infection having a transmission rate of 1.4% in study populations predominantly from industrialized countries (1.1 to 1.7%) (27).…”

Screening for Cytomegalovirus Infection During Pregnancy in a Teaching Hospital, Western province, Sri Lanka

“…From the 90% of newborns who are asymptomatic at birth develop symptoms like SNH in later life. In contrast, recurrent CMV infection carries the rate of newborn infection of about 1% with the 1%-10% of babies present with symptoms at birth 6,7 .Children with congenital CMV infection following first trimester maternal infection are more likely to have central nervous system sequelae, whereas infection acquired in the third trimester has a high rate of intrauterine transmission but a favorable outcome 8 .…”