The human cytomegalovirus (CMV) is a major cause of congenital infections. A case-control descriptive study was conducted in Kirkuk, Iraq to determine the seroprevalence of CMV in women with bad obstetric history (BOH) compared to women with a normal previous pregnancy. The CMV IgG and IgM seroprevalence was higher in women with BOH. The CMV IgG seroprevalence was significantly influenced by pregnancy, age, residence and level of education. In addition, the current CMV infection was significantly associated with pregnancy, age, residence and education. Large families (crowding index >3) exhibited higher seroprevalence for CMV IgM (8.3%) and IgG (98.3%), but odd ratio (OR) showed no significant association between family size and seropositivity. The CMV IgG seropositivity was higher in working women (100%) compared to housewives (95.4%). However, the CMV IgM (current infection) was 6.8% in housewives and was not detected in any working women (0%). The OR exhibited no significant association between occupation and both IgM and IgG levels.

Bad obstetric history (BOH) is reported worldwide and is associated with social and psychological impacts. Cytomegalovirus and herpes simplex virus play an important role in the induction of adverse outcomes of pregnancy. Highest CMV IgG prevalence rate was reported for India (91.05%), while the lowest rate was reported for Iran (14.28%). Unfortunately, six studies in Iraq reported a high prevalence of CMV IgM in non-married, pregnant and women with BOH. The range of recent CMV infection in pregnant women with BOH was from 1.4% in Jordan to 60.2% in Iraq. In women with BOH, the highest HSV 2 prevalence (16.8%) was noted in India, while the lowest rate (1.69%) was reported in India also. In Arab countries, among women with BOH, HSV 2 IgG and IgM seroprevalence higher rates were reported for Iraq. This literature review highlights the high bacterial and viral maternal infection rate in the developing world. Urgent, concerted action is required to reduce the burden of these infections. In addition to raising awareness about the severity of the problem of maternal infections in the developing world, data from this review will be beneficial in guiding public health policy, research interests and donor funding towards achieving improvement in health care delivery.

Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, stillbirth, early neonatal death, and/or congenital anomalies [1]. The causes of BOH may be genetic, hormonal, abnormal maternal immune response, and maternal infection [2,3]. TORCH Complex: The TORCH infections can lead to severe fetal anomalies or even fetal loss. They are a group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion [4]. Primary infections caused by TORCH-Toxoplasma gondii, Rubella virus, cytomegalovirus (CMV), and herpes simplex virus (HSV)-are the major causes of BOH [5]. These infections usually occur before the woman realizes that she is pregnant or seeks medical attention. The primary infection is likely to have a more important effect on fetus than recurrent infection and may cause congenital anomalies, spontaneous abortion, intrauterine fetal death, intrauterine growth retardation, prematurity, stillbirth, and live born infants with the evidence of disease [6]. Most of the TORCH infections cause mild maternal morbidity but have serious fetal consequences [7]. The ability of the fetus to resist infectious organisms is limited and the fetal immune system is unable to prevent the dissemination of infectious organisms to various tissues [8]. TORCH infections in the mother are transmissible to fetus in the womb or during the birth process and cause a cluster of symptomatic birth defects. Many sensitive and specific tests are available for serological diagnosis of TORCH complex [9]; however, ELISA test is more routinely used for its sensitivity. An attempt is being made to find out the correlation of TORCH infection during pregnancy in the Iraqi population. Toxoplasma gondii is an obligate intracellular protozoan parasite, which is linked to one of the most prevalent chronic infections affecting one third of the world's human population [10].

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Introduction: HSV is a common human pathogen that lead to lifelong latent infection. Maternal infections may be associate with transmission to the fetus. The risk factors associated with HSV 2 seropositivity in pregnant women in Iraq are not well studied. Aim: The present study conducted to verify the prevalence of HSV 2 infections in women with bad obstetric history (BOH) in Kirkuk Governorate. Material and Methods: HSV 2 seropositivity among women aged 14 to 48 years was investigated by determination of HSV 2 IgG and IgM in a prospective, case control descriptive study. Results: The overall HSV 2 seroprevalence was 29.9%, with a non significant difference between women with BOH and women with normal pregnancy. HSV 2 IgM, as an indicator of current infection was demonstrated in 2% of the studied population, and was significantly (P= 0.002) higher in women with BOH compared to women with normal pregnancy. Both HSV 2 IgG and IgM were significantly varied with age groups, with trends of increasing with older ages. HSV 2 IgG was statistically significantly higher in working women (P=0.03) as compared to housewife. Conclusions: Significant association was found between HSV 2 seroprevalence and education levels, residence, smoking and animal exposure. Presence of pregnancy in women with HSV-2 latent infection was a risk factor for development of BOH.