Epstein–Barr virus infection in pregnancy—A prospective controlled study
Introduction
Epstein–Barr virus (EBV) is a member of the herpesvirus family and is one of the most common human viruses. For the majority of the population, EBV causes no clinical manifestations; however, it may cause infectious mononucleosis and also establish latent infection in cells of the immune system that associate with Burkitt's lymphoma and nasopharyngeal carcinoma.
EBV has several antigens identified by the immune system, for both the lytic (early and late antigen) and the latent phases. Serological tests include IgG and IgM against the viral capsid antigen (VCA) that is detectable during the acute phase. IgG to EBV nuclear antigens (EBNA) becomes detectable later, in the latent phase. Positive EBNA implies that current status is at least several weeks to months after the onset of infection and excludes the acute phase [1].
There are only a few studies regarding the possible effects of EBV on the developing embryo and fetus. Generally, these studies found no evidence of significant EBV induced teratogenicity.
The rate of primary EBV infection in pregnant women seems to be very low, due to the high seroprevalence of EBV in the general population. Purtilo and Sakamoto [2] indicate an increase in several serologic markers of reactivation during pregnancy and speculate that pregnant women have a higher incidence of EBV reactivation, as the cellular immune responses to EBV seem to be suppressed during pregnancy. In contrast, Meyohas et al. [3] suggest that there is no significant effect of pregnancy on the percentage of EBV infected peripheral blood mononuclear cells.
Due to the potential presence of EBV in cervical secretions, it is often impossible to exclude perinatal transmission to the infants. However, if symptoms of EBV infection are diagnosed in infants delivered by cesarean section, it is presumed that it is due to intrauterine infection.
In this study, we prospectively evaluated pregnancies of women who contacted the Israeli Teratogen Information Service (Israeli TIS) regarding EBV exposure in pregnancy. We assessed the rate of major anomalies after pregnancy exposure to primary, recurrent or undetermined EBV infections and compared these rates to a control group exposed to non-teratogens. In addition, we compared pregnancy outcome, birth weight and gestational age at delivery between the groups.
Section snippets
Study design
The Israeli TIS is a counseling service in regards to environmental exposures during pregnancy.
This prospective controlled study enrolled pregnant women who or whose physician contacted the Israeli TIS seeking counseling regarding the potential risk of EBV exposure during pregnancy between the years 1991 and 2004.
The EBV exposed group was compared to a randomly selected control group of 1434 women who contacted our TIS seeking information in the same time frame, about the possible risk of
Results
There were 352 calls to the Israeli TIS regarding EBV exposure during pregnancy. Follow-ups were obtained prospectively for 207 pregnancies (58.9%). The remaining 145 cases were lost to follow-up due to technical reasons such as telephone disconnection, or change of address. It was not due to refusal to answer the questionnaire.
In 81 of the 207 followed up pregnancies (39.1%), the IgM was negative or not known. These women were excluded from this study.
Of the remaining 126 pregnancies, 27
Discussion
There are only few publications on the outcome of EBV infection during pregnancy, most of them are case reports [5], [6], [7], [8], [9], [10]. To the best of our knowledge, a prospective study with large numbers of active EBV infection during pregnancy has not been published to date.
In the present study we evaluated 126 pregnant women with EBV exposure during pregnancy compared to a control group of women exposed to non-teratogenic agents. The infection profile was determined by serology during
References (22)
- et al.
Reactivation of Epstein–Barr virus in pregnant women: social factors, and immune competence as determinants of lymphoproliferative diseases—a hypothesis
Med Hypotheses
(1982) - et al.
Infectious mononucleosis and congenital anomalies
Am J Obstet Gynecol
(1978) - et al.
infectious mononucleosis complicating pregnancy with fetal congenital anomaly of infant
Am J Obstet Gynecol
(1949) - et al.
Epstein–Barr virus infections in pregnancy: a prospective study
J Pediatr
(1984) - Red Book: 2000 report of the committee on infectious diseases, 25 ed. Elk Grove Village, IL: American Academy of...
- et al.
Study of mother-to-child Epstein–Barr virus transmission by means of nested PCRs
J Virol
(1996) - et al.
The teratogenicity of anticonvulsant drugs
N Engl J Med
(2001) - et al.
Congenital Epstein–Barr virus infection
Monatsschr Kinderheilkd
(1993) - et al.
Prospective study of Epstein Barr virus (EBV) infection during pregnancy
Biomedicine
(1981) - et al.
Infectious mononucleosis during gestation: report of three women and their infants studied prospectively
Pediatr Infect Dis
(1984)
The association of extrahepatic bile duct atresia and neonatal Epstein–Barr virus infection
Acta Paediatr Scand
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