Xiaoqian Lin1, Jingmei Wang2, Zhiqun Wang3, Tong Ru4, Yimin Dai5, Jie Li6, Xiangyu Zhu7, Jingli Liu8, Xiaodong Ye9, Bin Zhu10, Yi-Hua Zhou11, Yali Hu12. 1. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: michaelqian88@126.com. 2. Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: jingmei027@126.com. 3. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: ji_wang304@163.com. 4. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: 15380951881@163.com. 5. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: nj_daiyimin@126.com. 6. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: jie1967@126.com. 7. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: xiangyuzhu82@sina.com. 8. Department of Experimental Medicine, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: jingliliu1@163.com. 9. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: 273434703@qq.com. 10. Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: glyyyxk@163.com. 11. Department of Experimental Medicine, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Department of Infectious Diseases, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China. Electronic address: zgr03summer@126.com. 12. Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China. Electronic address: dtylhu@126.com.
Abstract
BACKGROUND: Cytomegalovirus (CMV) is a significant cause of fetal abnormalities in developed world. Whether this could be applied in developing world remains unknown. OBJECTIVES: To investigate CMV infection in severe fetal malformations in China. STUDY DESIGN: During 2007-2014, 436 fetuses (237 males) with severe malformations and terminated pregnancy at median gestational age of 26(+1) weeks were enrolled. CMV DNA was detected in fetal kidneys and other tissues by real-time PCR, and CMV IgG and IgM were measured by ELISA. RESULTS: CMV DNA was positive in kidneys and other tissues of seven (1.60%) fetuses. Hematoxylin-eosin staining showed intranuclear and intracytoplasmic inclusion bodies in kidneys of three fetuses, which was also positive for CMV antigens in immunohistochemistry. CMV DNA was found in 5 (6.1%) of 82 fetuses with central nervous system anomalies, 1 (11.1%) of 9 fetuses with abdominal anomalies, 1 (0.59%) of 168 fetuses with multiple congenital malformations, and none of fetuses with other anomalies (177). Of 293 pregnant women with plasma available, 279 (95.2%) were CMV IgG positive only and 6 (2.1%) were CMV IgG and IgM positive. Of 5 mothers with infected fetuses 1 (20%) was CMV IgG and IgM positive, while 5 (1.7%) of 288 mothers with uninfected fetuses were positive respectively (P=0.099). CONCLUSIONS: Congenital CMV infection in fetuses with severe congenital malformations is rare, indicating no close association between CMV infection and severe fetal malformations in China. Maternal screening for CMV may have minimal value in identifying fetal malformations in developing world.
BACKGROUND: Cytomegalovirus (CMV) is a significant cause of fetal abnormalities in developed world. Whether this could be applied in developing world remains unknown. OBJECTIVES: To investigate CMV infection in severe fetal malformations in China. STUDY DESIGN: During 2007-2014, 436 fetuses (237 males) with severe malformations and terminated pregnancy at median gestational age of 26(+1) weeks were enrolled. CMV DNA was detected in fetal kidneys and other tissues by real-time PCR, and CMV IgG and IgM were measured by ELISA. RESULTS: CMV DNA was positive in kidneys and other tissues of seven (1.60%) fetuses. Hematoxylin-eosin staining showed intranuclear and intracytoplasmic inclusion bodies in kidneys of three fetuses, which was also positive for CMV antigens in immunohistochemistry. CMV DNA was found in 5 (6.1%) of 82 fetuses with central nervous system anomalies, 1 (11.1%) of 9 fetuses with abdominal anomalies, 1 (0.59%) of 168 fetuses with multiple congenital malformations, and none of fetuses with other anomalies (177). Of 293 pregnant women with plasma available, 279 (95.2%) were CMV IgG positive only and 6 (2.1%) were CMV IgG and IgM positive. Of 5 mothers with infected fetuses 1 (20%) was CMV IgG and IgM positive, while 5 (1.7%) of 288 mothers with uninfected fetuses were positive respectively (P=0.099). CONCLUSIONS:Congenital CMV infection in fetuses with severe congenital malformations is rare, indicating no close association between CMV infection and severe fetal malformations in China. Maternal screening for CMV may have minimal value in identifying fetal malformations in developing world.