Viral infections in stillbirth: a contribution underestimated in Mexico?

Abstract

Objectives To analyze the role of viral infections as etiology of stillbirths in Mexico and their epidemiological impact in the context of the global Every Newborn Initiative. Methods A comprehensive literature search was performed in electronic databases related to stillbirth and viral infections published prior to January 19th 2021. Stillbirths records and causes from National Mexican databases, during 2008–2019 period were also computed. Results Only two articles with a direct relationship between viral infection and stillbirth were found, and one article with an indirect serological association was identified. During the analyzed period there were 198,076 stillbirths, with a National stillbirth rate (SBR) ranging from 6.9 to 6.5 between 2008 and 2014, with a subsequent increase to reach 7.7 in 2019. Only 19 cases were attributed to viral causes and a specific virus was identified in 11. The main causes of early stillbirth were a fetus with premature rupture of membranes and light for gestational age, and for late stillbirth these were fetus affected by oligohydramnios and slow fetal growth. The percentage classified as unspecified deaths varied from 34.4-41.9%. Conclusions In Mexico, there has been an increase in SBR during last years, but the goals of the Every Newborn Initiative is met. More than 14,500 stillbirths with at least 5,100 unspecified cases have been reported per year, and only 11 cases were attributable to a specific virus, highlighting the serious underestimation of cases and the need of implementation of routine viral diagnosis methods to improve the care of this global health problem.

The Vaginal Microbiome during Pregnancy in Health and Disease

“…Viruses known to cause fetus damage during infection, and, thus, potentially associated with stillbirth, are rubella, measles, CMV, varicella zoster, HSV, PVB19, and the human HIV [167,168]. Term placentas from congenital CMV infection showed pathologic findings that suggested the viral infection contributed to intrauterine growth restriction; in addition, CMV has been identified in several tissues of fetus with intrauterine death [169].…”