Top

Published in:

Open Access 01-12-2023 | Preterm Labor | Research

Screening for maternal cytomegalovirus infection during pregnancy and pregnancy outcome in patients with liver disease: an observational study

Authors: Rasha Eletreby, Rasha Abdelaziz, Hend Ibrahim Shousha, Zeinab Hammam, Ayman Hany, Dina Sabry, Basma Elawady, Naglaa Zayed, Ayman Yosry, Shereen Abdel Alem

Published in: BMC Infectious Diseases | Issue 1/2023

Abstract

Background

Cytomegalovirus (CMV) infection among pregnant females could induce CMV hepatitis with possible changes in liver stiffness measurement (LSM) which could be reversibly increased during normal pregnancies, particularly in the third trimester. This study aimed to detect the prevalence of CMV infection among pregnant females with and without chronic liver disease and to evaluate the effects of CMV infection on LSM and pregnancy outcomes in comparison to non-CMV-infected pregnant females.

Methods

This is an observational prospective study that included 201 pregnant ladies presented to the liver disease with pregnancy clinic, Cairo University from March 2018 to April 2019. We assessed the laboratory results, abdominal ultrasonography, LSM using ARFI elastography, and pregnancy outcomes.

Results

Two hundred and one pregnant ladies were divided into ; group 1: pregnant ladies with normal pregnancy (n = 128), group 2: pregnant ladies with chronic liver diseases not related to pregnancy (n = 35), and group 3: pregnant ladies with pregnancy-related liver diseases (n = 38). Positive CMV serology (either/or, +ve CMV-IgM, IgG) was detected in 106/201 patients (52.74%), and fifteen of them had an active infection (IgG +, IgM+, PCR+). Pregnant females with chronic liver diseases not related to pregnancy had significantly higher serum levels of CMV IgM, IgG, and PCR. Moreover, LSM had a significant correlation with CMV IgG and CM_PCR in normal pregnant ladies. Maternal mortality occurred only in pregnant females with chronic liver diseases in 5.7% (2/35).

Conclusion

Maternal CMV infection carries a significant risk to pregnant females with chronic liver disease. Routine CMV screening for women planning to be pregnant, especially those with chronic liver disease could help to avoid bad maternal and fetal outcomes.

Al Mana H, Yassine HM, Younes NN, Al-Mohannadi A, Al-Sadeq DW, Alhababi D, Nasser EA, Nasrallah GK. The Current Status of Cytomegalovirus (CMV) Prevalence in the MENA Region: A Systematic Review. Pathogens. 2019 Oct 31;8(4):213.

Cytomegalovirus (CMV) and Congenital CMV Infection. Center for Disease Control and Prevention (CDC). Visited on 27/2/2021. https://www.cdc.gov/cmv/clinical/congenital-cmv.html.

Ludwig A, Hengel H. Epidemiological impact and disease burden of congenital cytomegalovirus infection in Europe. Euro Surveill. 2009;14(9):26–32.CrossRefPubMed

Adler SP, Nigro G, Pereira L. Recent advances in the prevention and treatment of congenital cytomegalovirus infections. Semin Perinatol. 2007;31:10–8.CrossRefPubMed

Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63:425–33.CrossRefPubMedPubMedCentral

Nigro G, Anceschi MM, Cosmi EV, Congenital Cytomegalic Disease Collaborating Group. Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection. BJOG. 2003;110:572.CrossRefPubMed

Nakase H, Herfarth H. Cytomegalovirus Colitis, Cytomegalovirus Hepatitis and systemic cytomegalovirus infection: common features and differences. Inflamm Intest Dis. 2016;1:15–23.CrossRefPubMedPubMedCentral

Faivre M, Cottet V, Bour JB, Richou C, Valmary-Degano S, Thiefin G, CirCE Study Group, et al. Impact of cytomegalovirus infection on the outcome of patients with cirrhosis: a preliminary study. J Clin Gastroenterol. 2019 Mar;53(3):236–41.

Redman J, Sterling RK. Non-invasive Assessment of Liver Fibrosis. Curr Treat Options Gastro. 2020;18:255–69. https://doi.org/10.1007/s11938-020-00285-z.CrossRef

10.

Ribeiro MS, Hagström H, Stål P. Ajne G. Transient liver elastography in normal pregnancy – a longitudinal cohort study. Scand J Gastroenterol. 2019;54(6):761–5.CrossRef

11.

Li H, Weng P, Najarro K, Xue Q-L, Semba RD, et al. Chronic CMV infection in older women: longitudinal comparisons of CMV DNA in peripheral monocytes, anti-CMV IgG titers, serum IL-6 levels, and CMV pp65 (NLV)-specific CD8 + T-cell frequencies with twelve year follow-up. Exp Gerontol. 2014;0:84–9. https://doi.org/10.1016/j.exger.2014.01.010.CrossRefPubMedCentral

12.

Cremer NE. Antibodies in serodiagnosis of viral infection. In: Lennett EH, editor. Laboratory diagnosis of viral infection. New York: Mercel Dekker, Inc.; 1985. p. 73.

13.

Starr SE, Friedman HM et al. “Human CMV.“ Chap. 65. In Manual of Clin. Microbiol., 4th ed., Lennett, E.H. ed. Am. Soc. Microbiol. 1985, pp. 771 – 719.

14.

Voler A, Bidwell JE et al. Manual of clinical immunology. Chapter 69. Rose, N. and Friedman, H. eds. Am. Soc. Microbiol., 1985. p.506.

15.

Pfeifer L, Adler W, Zopf S, Siebler J, Wildner D, Goertz RS, Schellhaas B, Neurath MF, Strobel D. Acoustic radiation force impulse elastography: comparison and combination with other noninvasive tests for the diagnosis of compensated liver cirrhosis. Eur J Gastroenterol Hepatol. 2017;29(5):524–30.CrossRefPubMed

16.

Mhandire D, Rowland-Jones S, Mhandire K, Kaba M, Dandara C. Epidemiology of Cytomegalovirus among pregnant women in Africa. J Infect Dev Ctries. 2019;13(10):865–76.CrossRefPubMed

17.

Zaki M, El Shabrawy W. Value of immunoglobulin G avidity for primary cytomegalovirus diagnosis in pregnant women compared to nested polymerase chain reaction,Microbiologia Medica2016; 31:4914].

18.

Kamel N, Metwally L, Gomaa N, Gomaa WA, Sayed Ahmed M, Lotfi S, Younis A. Primary cytomegalovirus infection in pregnant egyptian women confirmed by cytomegalovirus IgG avidity testing. Med Princ Pract. 2014;23:29–33.CrossRefPubMed

19.

Porobic-Jahic H, Skokic F, Ahmetagic S, Piljic D, Jahic R, Petrovic J. Cytomegalovirus Infection in Pregnancy - Our Experiences. MED ARCH. 2019 JUN; 73(3): 149–153. https://doi.org/10.5455/medarh.2019.73.149-153

20.

Mohammad M, Almosawi H. A comparative study between PCR and immunoglobulin level in the diagnosis and monitoring of CMV infection in women in Babylon province. Int J Curr Microbiol App Sci. 2014;3(7):117–31.

21.

Gredmark S, Jonasson L, Van Gosliga D, Ernerudh J, Sderberg-Naucler C. Active cytomegalovirus replication in patients with coronary disease. Scand Cardiovasc J. 2007;41:230–4.CrossRefPubMed

22.

Görzer I, Kerschner H, Redlberger-Fritz M, Puchhammer-Stöckl E. Human cytomegalovirus (HCMV) genotype populations in immunocompetent individuals during primary HCMV infection. J Clin Virol. 2010;48(2):100–3.CrossRefPubMed

23.

Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease::Hepatic Medicine: Evidence and Research2010:2 49–67.

24.

Ammon F, Kohlhaas A, Elshaarawy O, Mueller J, Bruckner TH, Sohn CH, Fluhr G, Fluhr H, Muelle S. Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia. World J Gastroenterol. 2018;24(38):4393–402.CrossRefPubMedPubMedCentral

25.

Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.CrossRefPubMed

26.

Millonig G, Reimann FM, Friedrich S, Fonouni H, Mehrabi A, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48:1718–23.CrossRefPubMed

27.

Millonig G, Friedrich S, Adolf S, Fonouni H, Golriz M, Mehrabi A, Stiefel P, Pöschl G, Büchler MW, Seitz HK, Mueller S. Liver stiffness is directly influenced by central venous pressure. J Hepatol. 2010;52:206–10. 10.1016/ j.jhep.2009.11.018]. [PMID: 20022130.CrossRefPubMed

28.

Mueller S, Seitz HK, Rausch V. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol. 2014;20:14626–41. https://doi.org/10.3748/wjg.v20.i40.14626]. [PMID: 25356026.CrossRefPubMedPubMedCentral

29.

Fatima T, Siddiqui H, Ghildiyal S, i Baluni M, et al. Cytomegalovirus infection in pregnant women and its association with bad obstetric outcomes in Northern India. Microb Pathog. 2017;113:282.CrossRefPubMed

30.

Tan J, Surti B, Saab S. Pregnancy and cirrhosis. Liver Transpl. 2008;14:1081–91.CrossRefPubMed

31.

Sowjanya and Sudha. Cirrhosis with Portal Hypertension in Pregnancy IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279 – 0853, p-ISSN: 2279 – 0861. Volume 14, Issue 4 Ver. IV (Apr. 2015), PP 10–11 www.iosrjournals.org DOI: https://doi.org/10.9790/0853-14441011 www.iosrjournals.org 10 | Page.

32.

Britton RC. Pregnancy and esophageal varices. Am J Surg. 1982;143:421–5.CrossRefPubMed

33.

Russell MA, Craigo SD. Cirrhosis and portal hypertension in pregnancy. Semin Perinatol. 1998;22:156–65.CrossRefPubMed

Title: Screening for maternal cytomegalovirus infection during pregnancy and pregnancy outcome in patients with liver disease: an observational study
Authors: Rasha Eletreby
Rasha Abdelaziz
Hend Ibrahim Shousha
Zeinab Hammam
Ayman Hany
Dina Sabry
Basma Elawady
Naglaa Zayed
Ayman Yosry
Shereen Abdel Alem
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Preterm Labor
Published in: BMC Infectious Diseases / Issue 1/2023
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-023-08144-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Correction to: Comparing the performance of dengue virus IgG and IgG-capture enzyme-linked immunosorbent assays in seroprevalence study

A comparative analysis of cycle threshold (Ct) values from Cobas4800 and AmpFire HPV assay for triage of women with positive hrHPV results

Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in China: a cross-sectional study

Ophthalmic complications during the dengue epidemic in Reunion Island in 2020: a case series and review of the literature

Causal effects of genetically vitamins and sepsis risk: a two-sample Mendelian randomization study

Accuracy of saliva for SARS-CoV-2 detection in outpatients and their household contacts during the circulation of the Omicron variant of concern

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials