Gestational and Fetal Outcomes in B19 Maternal Infection: a Problem of Diagnosis

Abstract

Parvovirus B19 infection during pregnancy is a potential hazard to the fetus because of the virus' ability to infect fetal erythroid precursor cells and fetal tissues. Fetal complications range from transitory fetal anemia and nonimmune fetal hydrops to miscarriage and intrauterine fetal death. In the present study, 72 pregnancies complicated by parvovirus B19 infection were followed up: fetal and neonatal specimens were investigated by serological and/or virological assays to detect fetal/congenital infection, and fetuses and neonates were clinically evaluated to monitor pregnancy outcomes following maternal infection. Analysis of serological and virological maternal B19 markers of infection demonstrated that neither B19 IgM nor B19 DNA detected all maternal infections. IgM serology correctly diagnosed 94.1% of the B19 infections, while DNA testing correctly diagnosed 96.3%. The maximum sensitivity was achieved with the combined detection of both parameters. B19 vertical transmission was observed in 39% of the pregnancies, with an overall 10.2% rate of fetal deaths. The highest rates of congenital infections and B19-related fatal outcomes were observed when maternal infections occurred by the gestational week 20. B19 fetal hydrops occurred in 11.9% of the fetuses, and 28.6% resolved the hydrops with a normal neurodevelopment outcome at 1-to 5-year follow-up. In conclusion, maternal screening based on the concurrent analysis of B19 IgM and DNA should be encouraged to reliably diagnose maternal B19 infection and correctly manage pregnancies at risk.Parvovirus B19 is a common human pathogen. The infection can occur asymptomatically, or it can be associated with a broad range of clinical features such as erythema infectiosum, postinfectious arthropathy, or transient aplastic crises in patients with hemolytic anemia and can complicate a pregnancy course. B19 is mainly transmitted via respiratory secretions and vertically by the transplacental route. B19 iatrogenic transmission has also been described by blood products (3).The prevalence of specific B19 IgG ranges from 15 to 60% in children to 30 to 60% in adults and is Ͼ85% in the geriatric population (13,14,18). In pregnant women, susceptibility to B19 infection has been estimated at 26 to 43.5%, with a seroconversion incidence of 0.61 to 2.4%. In an epidemic period, the incidence may increase up to 13.5% (12,15,22).The infection during pregnancy can have very different outcomes, ranging from the absence of maternal and fetal symptoms to transitory fetal anemia and nonimmune hydrops fetalis (NIHF) to miscarriage and intrauterine fetal death (IUFD). Fetal injuries such as fetal myocarditis, endothelial lesions, and fetal cerebral damages have been reported (9,19,21). Thrombocytopenia secondary to B19 infection can also occur (19), as well as congenital anomalies, including chronic anemia (4), meconium peritonitis (24), congenital heart disease (23), fetal hepatic calcifications (20), and bilateral opacification of the cornea (17). The pathogenesis of fetal damages d...

Parvovirus B19 Achievements and Challenges

“…Some case series also reported a high frequency of detection of B19 DNA in late intrauterine deaths [235][236][237], a finding not confirmed in other case series, that did not show such correlations and indicated that late intrauterine fetal death is a rare event [238]. Finally, the infected fetus may show presence of virus at birth [239,240]. Congenital infections have been sporadically associated with neonatal anemia or anomalies [241], while their possible consequences on the neurological development are currently investigated [242][243][244].…”

Maternal IgM antibody status in confirmed fetal cytomegalovirus infection detected by sonographic signs

“…It is well known that because of the pathophysiology of congenital CMV infection, several weeks may elapse before the appearance of sonographic findings of fetal infection . Previous studies on congenital parvovirus B19 infection have warned about maternal serum IgM levels possibly being low or undetectable at the time of clinically overt fetal hydrops, with substantial false negative results …”

Does an intrauterine exchange transfusion improve the fetal prognosis in parvovirus infection cases?

“…The infection was confirmed via a polymerase chain reaction analysis of the amniotic fluid. IUETs were indicated in the cases with fetal hydrops (i.e., accumulation of fluid in at least two fetal compartments including ascites, pericardial effusion, pleural effusion, subcutaneous effusion, placental thickness, and hydramnios) or an MCA‐PSV greater than 1.5 to 1.55 multiple of the median (MoM) …”