Parvovirus B19 Infection in the First Trimester of Pregnancy and Risk of Fetal Loss: A Population-based Case-Control Study

Abstract

Because parvovirus B19 infection during pregnancy has been associated with increased risk of fetal loss in small or selected study populations, the authors evaluated the risk in a population-based study. A nested case-control study was conducted by using a population-based screening for syphilis in 3 regions in Denmark from 1992 to 1994. Cases of women with fetal loss were identified in the National Patient Register (n = 2,918), and control women with live-born children were identified in the Medical Birth Register (n = 8,429) by matching on age and sampling week. First-trimester serum samples were tested for parvovirus B19 immunoglobulin M positivity. Parvovirus B19 immunoglobulin M positivity was associated with a 71% increased risk of fetal loss (odds ratio = 1.71, 95% confidence interval: 1.02, 2.86). Adjustment for number of children or stratifying for gestational age at loss did not change the risk estimate. Assuming causality, only 0.1% of fetal losses were attributable to parvovirus B19 positivity, a proportion which could increase to approximately 1% during epidemic periods. In conclusion, acute parvovirus B19 infection during the first trimester of pregnancy was associated with an increased risk of fetal loss. However, the impact on the overall burden of fetal losses appeared small even during epidemics.

Human Parvoviruses

“…Fetal loss early in pregnancy has been associated with first-trimester B19V infections. In a population-based Danish study, the presence of anti-B19V IgM almost doubled the risk of fetal loss, but only 0.1% of the losses were attributable to the virus (513). In a cross-sectional study of fixed tissue from fetal loss, 6% contained B19V DNA, all in first-trimester spontaneous abortions (514).…”

Parvovirus B19 Achievements and Challenges

“…Most studies have been performed by retrospective collection of data, while only a few have been based on prospective evaluation of population cohorts. Large population-based studies to determine the burden of prenatal infections have been carried out in a few settings [302][303][304][305]. In these cases, the incidence of reported cases of B19V infection has usually been exceedingly low.…”

Infection status of human parvovirus B19, cytomegalovirus and herpes simplex Virus-1/2 in women with first-trimester spontaneous abortions in Chongqing, China

“…However, this finding is different from other surveys which reported that B19V, CMV, and HSV-1/2 infections are associated with the increased risk of first-trimester spontaneous abortions [ 48 – 50 ]. For example, Lassen et al examined 2918 women, and found a correlation between acute B19V infection during the first trimester of pregnancy [ 49 ]. Besides, Kapranos et al reported a significant role of HSV in first-trimester spontaneous abortion, which indicated that 41 of 95 cases (43.2%) of early spontaneous abortion showed signs of HSV infection compared with 36 of 216 (16.7%) cases of elective pregnancy termination [ 51 ].…”