MATERNAL-FETAL VIRAL INFECTIONS
Giovanni Nigro, Director of the Pediatric Unit and School of the University of L’Aquila, Italy
General diagnostic approach
 Maternal-fetal infections (MFI) are more frequent than commonly believed, favoured by the
estrogen-enhanced immunodepression occurring in pregnancy, and the consequences
involve all medical and surgical fields even after many years from birth
 The most frequently immediate manifestations of MFI are preterm delivery and IUGR
 Fetal or neonatal manifestations are non-specific
 Serodiagnosis by detection of specific IgM and IgG antibodies is the first approach
 Avidity of specific IgG antibodies can differentiate recent or past infections
 Diagnosis of active based is based on the detection of causal agent by PCR, culture, or
antigens
 Prenatal diagnosis may be obtained by amniocentesis for detection of viral genome
 Diagnosis in the neonates is based on detection of the viral genome and specific IgM
RUBELLA
 Susceptibility in pregnancy: 5-15%
 Congenital rubella is an evolutive disease with late sequelae (~ 90%): cataract,
chorioretinitis, deafness, cardiopathy, microcephaly, blueberrymuffin, pneumonia, hepatitis,
anemia, mental retardation, characterial troubles, IDDM
HERPES SIMPLEX VIRUS
 Transmission by primary infection (rarely recurrent)
 Perinatal infection: encephalitis, muco-cutaneous or systemic infection, pneumonia,
esophagitis
 Congenital transmission (extremely rare): chorioretinitis, microphtalmia, microcephaly
 Therapy: acyclovir
HIV
 Transmission:
- related to the low number of CD4+ T-cells
- reduced to 5% using anti-retroviral therapy and cesarean section
 Neonatal manifestations: hepatosplenomegaly, lymphadenopathy, opportunistic infections
VARICELLA
 Neonatal manifestations:
- by congenital transmission (I trimester): cicatritial lesions, hypoplasia or paresis of the
limbs, cataract, microphtalmia, chorioretinitis, cerebral atrophy, periventricular
calcifications, hydrocephalus
- by perinatal transmission: severe varicella
 Therapy: aciclovir
HEPATITIS VIRUSES
 HBV: transmission during delivery: chronic liver disease frequently develops
 HCV: vertical transmission occurs in about 6% of mothers (10-15% if HIV infection
is concomitant), depending on the maternal viral load
PARVOVIRUS B19
• Pathogenicity: replication in the nuclei of erythroid cells (main target pronormoblasts)
• I trimester: fetal death
• II trimester: fetal hydrops (aplasia > severe anemia > edema > viral spread > hemolysis)
• III trimester: stillbirth
CYTOMEGALOVIRUS
 The most common congenital infection: following both primary and recurrent infection,
active CMV infection occurs in 3 to 6% of pregnant women and 0.4 to 2.2% of neonates
 Symptomatic congenital CMV infection: signs of reticuloendothelial (hepatosplenomegaly,
jaundice, thrombocytopenia) and neurological (seizures, hyper- or hypotonia, microcephaly and
periventricular calcifications, neuronal migrational disorders, sensorineural hearing loss)
involvement; ocular manifestations (chorioretinitis, microphthalmia, cataract), pneumonia and
purpuric rash may also occur.
 Therapy of severe congenital CMV disease: ganciclovir
 Possible use of CMV-specific immunoglobulins for fetal infection or prevention of
maternal-fetal transmission following primary maternal infection
Main targets of the study group
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Antenatal screening: is it necessary, useful or unnecessary ?
Screening in pregnancy: should this be done only in seronegative women or also in
seropositive women
Prevalence and symptoms of active viral infection (as shown by specific IgM antibodies,
genome detection, seroconversion, significant increase/decrease of IgG levels) and
maternal-fetal transmission in pregnancy in different European countries
Diagnostic procedures: role of specific antibodies, including IgG-avidity, DNA and
antigen detection, culture; there is a need to obtain standardization of the technique and
reproducibility of results
Role of the immunity in maternal-fetal transmission; possible correlations between
maternal cell-mediated immunity and clinical expression of fetal infection
Value of the viral load in the amniotic fluid for prenatal diagnosis
Clinical, laboratory and ultrasound monitoring in pregnant women with viral infections
Therapeutic approaches towards viral infection in pregnancy: immunoglobulins,
antiviral drugs
Pediatric follow-up: how this should be done and for how long ?
Therapy of congenital viral infections: only symptomatic infections? Which kinds of
symptoms and signs are to be considered?
Preventive use of antivirals in infants asymptomatic at birth, particularly if HIV-positive
or otherwise immunodeficient?