|Year : 2001 | Volume
| Issue : 2 | Page : 52-56
Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy
P Yasodhara , BA Ramalakshmi , AN Naidu , L Raman
National Institute of Nutrition, Indian council of Medical Research, Jamai Osmania P.O., Hyderabad, - 500 007, India
National Institute of Nutrition, Indian council of Medical Research, Jamai Osmania P.O., Hyderabad, - 500 007, India
One hundred and seventy five apparently normal asymptomatic pregnant women were studied prospectively and 247 women with different complications of pregnancy were screened at the time of delivery for infections like Chlamydia trachomatis, Toxoplasma, Rubella and cytomegalovirus (CMV). One hundred and forty two women with normal outcome of pregnancy served as controls. Specific IgM due to these agents were determined in the sera using commercial diagnostic kits. Results of the study showed that chlamydial infection was the most prevalent (29.8%) followed by Toxoplasmosis (13.1), Rubella (6.5%) and CMV (5.8%). Adverse outcome was seen among those seropositive for Chlamydia, Toxoplasmosis and Rubella. CMV showed no association with adverse outcome of pregnancy. Since Chlamydia and Toxoplasmosis are amenable to treatment with antibiotics, screening for these infections and appropriate treatment would improve outcome of pregnancy.
|How to cite this article:|
Yasodhara P, Ramalakshmi B A, Naidu A N, Raman L. Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy. Indian J Med Microbiol 2001;19:52-6
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Yasodhara P, Ramalakshmi B A, Naidu A N, Raman L. Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy. Indian J Med Microbiol [serial online] 2001 [cited 2019 Jun 26];19:52-6. Available from: http://www.ijmm.org/text.asp?2001/19/2/52/6925
In India, pregnant women belonging to low socio-economic group may be exposed to a variety of infections due to poor environment and hygiene. Maternal infections which have been considered as significant factors in the causation of poor pregnancy outcome elsewhere have not assumed much significance in India since their prevalence and effect on pregnancy outcome have not been studied so far. Data is scanty because of the technical difficulties in isolating the organisms and the requirement for use of commercial diagnostic kits which are expensive. Chlamydia trachomatis is a sexually transmitted agent, is asymptomatic in nearly 50% of infected women but has serious consequences. , Few reports from developing countries show the prevalence in pregnant women ranging from 7-45%. Toxoplasmosis is a protozoan infection, which is asymptomatic and if acquired during pregnancy especially as a primary infection may cause damage to the fetus.,,, Apart from being transmitted through infected cat's faeces, it is now shown to be transmitted through contaminated vegetables, fruits and milk. Most of the available information on Toxoplasmosis from India was in women with pregnancy wastages.,,,, Rubella and CMV are viral infections which are reported to cause damage to the fetus if acquired during pregnancy.,,,,
In the present paper, we report the prevalence of these infections during pregnancy and their effect on outcome of pregnancy.
| ~ Materials and Methods|| |
The study was carried out in 2 phases. Phase I was a prospective study where 175 women who came for antenatal checkup and were willing to participate in the study formed the study group. Blood samples were drawn from these women during 28-32 weeks of gestation and the women were followed upto delivery. The age of the women ranged between 16-35 years and parity between 1-5. Information on education, occupation, previous obstetric history, and medical history was also recorded. Nutritional anthropometry and haemoglobin were done. Delivery outcome was recorded with reference to gestational age at delivery and timing of rupture of membranes. Information on still births and congenital malformations was recorded. Birth weight and type of delivery were recorded. In Phase-II, blood samples were collected at the time of delivery or abortion from 247 women with different complications of pregnancy like premature delivery (PMD), preterm premature repture of membranes (PPROM), spontaneous abortions (sp.Ab), still births (SB) and congenital anomalies. One hundred and forty two women with normal pregnancy outcome were also included. Sera were separated and stored at 4° C until analysis. Specific IgM antibodies to different infections were determined using commercial diagnostic kits. Ipazyme IgM, Savyon diagnostics, Israel was used to determine Chlamydial antibodies. The test uses C.trachomatis L2-serovar infected McCoy cells as antigen to detect specific IgM antibodies. Specific IgM antibodies to Rubella, CMV and Toxoplasma were determined using Microelisa kits obtained from Diamedix Corp. Ltd., USA. Antibodies to HSV were not determined. Chlamydial IgM could be determined only in 79 samples in the prospective study according to availability of kits.
Test of significance of binomial proportion was used to compare the difference between the groups. Odds Ratio (OR), relative risk and 95% confidence interval (CI) were also calculated to assess the significance between the groups using SPSS 10.0 for windows.
| ~ Results|| |
Majority of the women in phase I were between 20-30 years of age belonging to low socio-economic group (85%) and education ranged from illiterate (35%) to higher education (65%). The mean age was 22.3+3.5 years, height 150.9+5.16 cms, weight 48.2+6.39 kgs, parity 2.3+1.15, and haemoglobin 10.2+1.43 gms/dl. There were no significant differences bwtween the seropositives and seronegatives in any of the above parameters. 70% of the women had haemoglobin <11 gm% while nearly 30% had BMI <18.5. Results of the prospective study [Table - 1] showed that chlamydial infection (29.3%) was most prevalent followed by Toxoplasma (13.1%), Rubella (6.5%) and CMV (5.8%).
a. C.trachomatis infection
Of the 79 women studied, 29.3% were positive for specific IgM. A higher percentage of seropositives had adverse outcome (PMD and PPROM, 26.08%) compared to the seronegatives (10.7% P <0.05, or R 4.44, RR 3.25). However, there was no difference in the mean birth weights between the seropositives (2.82+0.351) and seronegatives (2.84+0.337) or percentage prevalence of intrauterine growth retardation (8.7% vs 14.3%).
Of the 175 women screened for Toxo specific IgM, 13.1% were positive for specific IgM. A significantly higher percentage of seropositives had adverse otucome of pregnancies compared to seronegatives (34.7% vs 14.08% P<0.05, OR 4.23, RR 3.11).
c. CMV and Rubella infection
5.8 and 6.5% of women were positive for CMV and Rubella specific IgM respectively. A higher percentage of women positive for rubella specific IgM had poor pregnancy outcome like very low birth weight, PMD and anencephaly (44.4% vs 19.3% OR 3.21, RR 2.41). Seropositivity to CMV did not show any association with poor pregnancy outcome.
Seven women were positive for both Chlamydia and Toxoplasma IgM antibodies, 2 women for Rubella and CMV and one for Chlamydia, Toxoplasma and Rubella antibodies. Five out of seven (71%) women positive for both Chlamydia and Toxoplasma antibodies had adverse outcome (PMD and PROM).
Analysis of the data on prevalence of infections in different complications of pregnancy (Phase II) is shown in [Table - 2]. 18.7% women with full term normal delivery were seropositive for chlamydial IgM antibody as compared to a significantly higher percentage (42%) of women with adverse outcome being seropositive (OR 3.15, RR 1.45). Seropositivity to Toxoplasma, Rubella and CMV on the other hand were not significantly different between those with normal outcome compared to those with adverse outcome.
The study group in phase II had the following mean age (22.7+6.21), height (150.5+5.55), weight (46.79+6.49), parity (1.5+5.55) and haemoglobin (10.2+1.43). There were no significant differences between those with and without infection in the above parameters.
One woman with spontaneous abortion was positive for Rubella, Chlamydia and Toxoplasma antibodies, while six were positive for both Toxoplasma and Chlamydia. Two women with PMD and one with PPROM was positive for both Toxoplasma and chlamydial antibodies. Among those with full term normal delivery, four women were positive for more than one infection - Rubella and Chlamydia (1) Toxoplasma and Chlamydia (2) and CMV and Chlamydia (1).
| ~ Discussion|| |
Although information on infections during pregnancy is available from India,,,,,,,,,,, very little data exists in relation to pregnancy outcome.
This study carried out on a fairly large sample, shows that Chlamydia is the most prevalent infection followed by Toxoplasmosis, Rubella and CMV. The reported prevalence of chlamydial infection is 2-20% in pregnancy. However, studies on association of adverse pregnancy outcome like PMD, PPROM still births and abortions are controversial, some studies supporting while others
not.,,,,, The present study shows that chlamydial infection is highly prevalent in our women and is associated with adverse outcome of pregnancy. Since the infection is amenable to antibiotic therepy, screening and appropriate treatment may improve the outcome. In both the infections (Toxoplasmosis and chlamydial), there was a higher prevalence of adverse outcome among the seropositives compared to the seronegatives. The magnitude of adverse outcome was several fold higher in women positive for both the infections. A recent study from Chandigarh shows a rising seropositivity to toxoplasmosis in women with bad obstetric history. This emphasises the need for regular screening of the pregnant women for these infections and timely treatment to prevent morbidity and mortality of the infants born to such mothers.
5.8% of the women were positive for CMV specific IgM although there was no association with adverse outcome of pregnancy. Higher seroprevalence of this infection was reported by two studies from other parts of India,. These studies also report an association with complications of pregnancy. However, the sample sizes were smaller in both studies. 6.5% of the mothers were positive for Rubella specific IgM and a higher percentage of adverse outcome of pregnancy was seen in these women similar to earlier reports.,, Thus the need for protection against this infection is further emphasized.
This study shows that chlamydia and toxoplasma infections are widespread among our pregnant women and these infections are associated with adverse outcome of pregnancy. Both infections are treatable.
Earlier, some studies did show that treated mothers had outcome similar to uninfected mothers., The Centre for Disease Control does recommend screening and treatment of pregnant women at risk for chlamydial infections. Therefore, further studies are needed to evaluate the effect of treatment on obstretric and neonatal morbidity from India.
| ~ Acknowledgement|| |
The authors thank the Director, NIN for her encouragement during the study and also thank Mr. T. Satyanarayana for secretarial assistance. Technical assistance by Mr. K. Lingarkar is gratefully acknowledged.
| ~ References|| |
|1.||McGregor JA, French JI. Chlamydia trachomatis infection during pregnancy. Am J Obstet & Gynecol 1991; 164: 82-83. |
|2.||Sweet RL, Launders DV, Warker C, Schachter J. Chlamydia trachomatis infection and pregnancy outcome. Am J Obstet & Gynecol 1987; 156: 824-833. |
|3.||Rowe PJ. Sexually transmitted diseases. "A challenge to reproductive health". In "challenges in reproductive health research". UNDP/UNFPA/WHO/World Bank special programme of R & d and Research Training in Human Reproduction. WHO, 1994. Biennial Report 1992-1993; pp 83-97. |
|4.||Koskiniemi M, Lappalainen M, Hedman K. Toxoplasmosis needs evaluation. An overview and proposals. AJDC 1989; 143: 724-728. |
|5.||Swarnakanta, Kasturi Lal K. Prevalence of Toxoplasma antibodies among pregnant women and its relation to pregnancy wastages. J Obset Gynecol India 1990; 40: 322-326. |
|6.||Sharma P, Gupta T, Ganguly NK, Mahajan RC, Malla N. Increasing Toxoplasma seropositivity in women with bad obstetric history and in new borns. Natl Med J 1997; 10: 65-66. |
|7.||Mehta AA, Mehta AC. Clinical presentation of Toxoplasmosis in pregnancy . J Obstet & Gynaec India 1990; 140: 165-170. |
|8.||Mistry B, Vinita S, Desai SV, Dhurandar JK, Ingle, KM. The role of toxoplasmosis in reproductive wastage. J Obstet Gynecol India 1989 39: 478-483. |
|9.||Dashore S, Dube S, Pandre V. Maternal toxoplasmosis in cases of pregnancy wastages. J Obstet Gynecol India 1991; 41: 17-20. |
|10.||Bhaskaran P, Ramalakshmi BA, Rama Raju LA, Raman L. Need for protection against Rubella in India. Ind J Paedr 1991; 58: 811-814. |
|11.||Shetty M, Latha J, Shivananda PG. Detection of IgM antibodies to Rubella in pregnant women by ELISA. Ind J Med Microbiol 1993; 11: 68-71. |
|12.||Sharma JB, Bukshee K. Rubella infection. A cause of fetal wastage. J Indian Med Assoc 1992; 90: 174-175. |
|13.||Kapil A, Broors. Primary Cytomegalovirus infection in pregnant and non-pregnant women. Indian J of Medical Microbiol 1992; 10: 53-55. |
|14.||Sunanda N, Thakar VS, Joshi SG, Saoji AM. Seroprevalence of cytomegalovirus specific IgM antibodies in pregnant women. A preliminary study. Indian J Med Microbiol 1994; 12:(1) 65-67. |
|15.||Amita Jain, Nag VL, Goel MM. Chandrawathi, Chaturvedi VC. Adverse fetal outcome in specific IgM positive Chlamydia trachomatis infection in pregnancy. Indian J Med Res 1991; 94: 420-423. |
|16.||Paul VK, Singh M, Gupta U, Buckshee K, Bharvava VL, Takkar D, Nag VL, Bhan MK, Deorai AK. Chlamydia trachomatis infection among pregnant women: Prevalence and perinatal importance. The Natl Med J 1999; 72: 11-13. |
|17.||Hardy PH, Hardy JB, Nell EE, Graham DA, Spence MR, Rosenbaum RC. Prevalence of six sexually transmitted disease agents among pregnant innercity adolescents and pregnancy outcome. Lancet 1994; 2: 333-337. |
|18.||Minkoff H, Grunebaum AN, Schwarz RH, Feldman J, Chumming M, Crombleholme W, Clark L, Pringle G, |
|19.||McGormack WM. Risk factors for prematurity and premature repture of membranes: a prospective study of vaginal flora in pregnancy. Am J Obstet Gynecol 1994; 150: 965-972. |
|20.||Harrison HR, Alexander ER, Weinstein L, Lewis M, Nash M, Sim DA. Cervical Chlamydia trachomatis and Mycoplasmal infections in pregnancy. Epidemiology and outcome. JAMA 1983; 250: 1721-1727. |
|21.||Cohen I, Veilli JC, Calkin BM. Improved pregnancy outcome following successful treatment of chlamydial infection. JAMA 1990; 263: 3160-3168. |
|22.||Ryan GM Jr., Abdella TN, McNeeley SG, Baselski VS, Drummond DE. Chlamydia trachomatis infection in pregnancy. Effect of treatment on outcome. Am J Obstet Gynecol 1990; 162: 34-39. |
|23.||Centres for Disease Control: Chlamydia trachomatis infections: Policy guidelines for prevention and control. MMWR (No. 35) 1995; 34: 605-695. |