Prevalence of a positive TORCH and parvovirus B19 screening in pregnancies complicated by polyhydramnios.

OBJECTIVE: The aim of this study was to evaluate the rate of women with polyhydramnios who eventually screened positive to infectious disease by serum screening testing for TORCH and parvovirus B19. METHODS: This is a retrospective observational study on singleton pregnancies with a diagnosis of polyhydramnios and who had serum screening for TORCH and parvovirus B19. Patients were followed with serial ultrasounds between 2006 and 2013. Maternal characteristics, medical and obstetric history were reviewed. Ultrasound parameters, including amniotic fluid index and fetal anomalies, and the results of serologic tests were reviewed. RESULTS: Two hundred ninety patients met the inclusion criteria. Of these, 56 (19%) presented one of the following pathological conditions associated with polyhydramnios: diabetes (13% of total cases), obstructive gastrointestinal lesions (5%), Rhesus isoimmunization (0.3%), chromosomal abnormalities or genetic syndromes (1%). Among the remaining 234 patients, only three had a positive test result for infectious disease (1%, 95% Confidence Interval (CI) 0-4%): two women were positive for parvovirus B19 and one for toxoplasmosis infection. In none of them the fetus was affected, as confirmed by serum testing after birth and by 3 years follow-up. CONCLUSIONS: Infectious disease screening does not seem beneficial in pregnancies with isolated polyhydramnios.

A pilot study using residual newborn dried blood spots to assess the potential role of cytomegalovirus and Toxoplasma gondii in the etiology of congenital hydrocephalus.

BACKGROUND: Congenital hydrocephalus is a condition characterized by accumulation of cerebrospinal fluid in the ventricles of the brain. Prenatal infections are risk factors for some birth defects. This pilot study investigated whether residual dried blood spots (DBS) could be used to assess infections as risk factors for birth defects by examining the associations between prenatal infection with Toxoplasma gondii (T. gondii) or cytomegalovirus (CMV) with congenital hydrocephalus. METHODS: Case-infants with hydrocephalus (N=410) were identified among live-born infants using birth defects surveillance systems in California, North Carolina, and Texas. Control-infants without birth defects were randomly selected from the same geographic areas and time periods as case-infants (N=448). We tested residual DBS from case- and control-infants for T. gondii immunoglobulin M and CMV DNA. When possible, we calculated crude odds ratios (cORs) and confidence intervals (CIs). RESULTS: Evidence for prenatal T. gondii infection was more common among case-infants (1.2%) than control-infants (0%; p=0.11), and evidence for prenatal CMV infection was higher among case-infants (1.5%) than control-infants (0.7%; cOR: 2.3; 95% CI: 0.48, 13.99). CONCLUSIONS: Prenatal infections with T. gondii and CMV occurred more often among infants with congenital hydrocephalus than control-infants, although differences were not statistically significant. This pilot study highlighted some challenges in using DBS to examine associations between certain infections and birth defects, particularly related to reduced sensitivity and specimen storage conditions. Further study with increased numbers of specimens and higher quality specimens should be considered to understand better the contribution of these infections to the occurrence of congenital hydrocephalus.

Screening for infectious diseases.

INTRODUCTION: Fetal brain injury is an essential cause of lifelong morbidity. Infection appears as a cause of brain damage. Apart from chorioamnionitis, screening for infectious diseases must be considered in pregnancies with a risk of congenital infection or cases with abnormal cerebral ultrasound findings. DISCUSSION: Congenital infections include most of the major components of the TORCH complex: toxoplasmosis, rubella, cytomegalovirus, herpes, and varicella. Seronegative mothers can develop primary infection, which carries a risk of vertical transmission. The timing of the infection is a critical point, because fetal damage often depends on the gestational age at which acute maternal infection took place and occurs more likely in the first half of pregnancy. Antenatal ultrasound can detect brain abnormalities, like hydrocephalus, periventricular leukomalacia, calcifications or hemorrhage. Maternal serologic tests must be performed to look for an infectious etiology; the most frequent agents are the components of the TORCH complex. But additional serology must include parvovirus B19, HIV, and coxsackieviruses.