Elsevier

Reproductive Toxicology

Volume 25, Issue 4, August 2008, Pages 468-471
Reproductive Toxicology

Epstein–Barr virus infection in pregnancy—A prospective controlled study

https://doi.org/10.1016/j.reprotox.2008.04.004Get rights and content

Abstract

Background

Epstein–Barr virus (EBV) is one of the most common human viruses. To date, there is limited information regarding the influence of maternal EBV infection on pregnancy outcome.

Objective

Our aim was to examine the fetal safety of EBV infection in pregnancy.

Study design

We prospectively evaluated the rate of major anomalies and pregnancy outcome of women with serologic evidence of primary, recurrent or undefined infection (27, 56, and 43 women, respectively) compared to 1434 women who called the Israeli TIS for non-teratogenic exposure.

Results

Women's characteristics and pregnancy outcome were comparable between the EBV exposed and control groups. Similarly, the gestational age at delivery and birth weight were not significantly different. The rate of major congenital anomalies did not significantly differ between the EBV exposed compared to the control group.

Conclusion

This study suggests that EBV infection during pregnancy does not represent a major teratogenic risk to the fetus.

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

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