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. 1993 Sep;159(3):366–373.

Prenatal diagnosis and significance of fetal infections.

A Ghidini 1, L Lynch 1
PMCID: PMC1011352  PMID: 8236979

Abstract

Viruses like rubella, cytomegalovirus, varicella-zoster virus and parasites like Toxoplasma gondii can be transmitted from a pregnant woman to her fetus and can affect fetal development. Several factors determine the likelihood of fetal infection and the risk of consequences for the fetus, such as the timing of transmission during gestation or the immunologic status of the mother. No single diagnostic modality can be applied to all infections. Knowledge of the diagnostic methods available is essential for accurate counseling and treatment of affected pregnant women.

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Selected References

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  1. Ades A. E. Evaluating the sensitivity and predictive value of tests of recent infection: toxoplasmosis in pregnancy. Epidemiol Infect. 1991 Dec;107(3):527–535. doi: 10.1017/s0950268800049220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alestig K., Bartsch F. K., Nilsson L. A., Strannegard O. Notes. Studies of amniotic fluid in women infected with rubella. J Infect Dis. 1974 Jan;129(1):79–81. doi: 10.1093/infdis/129.1.79. [DOI] [PubMed] [Google Scholar]
  3. Alexander I. Congenital varicella. Br Med J. 1979 Oct 27;2(6197):1074–1074. doi: 10.1136/bmj.2.6197.1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Balducci J., Rodis J. F., Rosengren S., Vintzileos A. M., Spivey G., Vosseller C. Pregnancy outcome following first-trimester varicella infection. Obstet Gynecol. 1992 Jan;79(1):5–6. [PubMed] [Google Scholar]
  5. Bale J. F., Jr, Murph J. R. Congenital infections and the nervous system. Pediatr Clin North Am. 1992 Aug;39(4):669–690. doi: 10.1016/s0031-3955(16)38370-5. [DOI] [PubMed] [Google Scholar]
  6. Berrebi A., Kobuch W. E., Puel J., Tricoire J., Herne P., Grandjean H., Pontonnier G. Influence of pregnancy on human immunodeficiency virus disease. Eur J Obstet Gynecol Reprod Biol. 1990 Dec;37(3):211–217. doi: 10.1016/0028-2243(90)90027-x. [DOI] [PubMed] [Google Scholar]
  7. Binder N. D., Buckmaster J. W., Benda G. I. Outcome for fetus with ascites and cytomegalovirus infection. Pediatrics. 1988 Jul;82(1):100–103. [PubMed] [Google Scholar]
  8. Butz A., Hutton N., Larson E. Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women. Am J Public Health. 1991 Oct;81(10):1323–1326. doi: 10.2105/ajph.81.10.1323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cazenave J., Forestier F., Bessieres M. H., Broussin B., Begueret J. Contribution of a new PCR assay to the prenatal diagnosis of congenital toxoplasmosis. Prenat Diagn. 1992 Feb;12(2):119–127. doi: 10.1002/pd.1970120207. [DOI] [PubMed] [Google Scholar]
  10. Cederqvist L. L., Zervoudakis I. A., Ewool L. C., Senterfit L. B., Litwin S. D. Prenatal diagnosis of congenital rubella. Br Med J. 1977 Mar 5;1(6061):615–615. doi: 10.1136/bmj.1.6061.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Courgnaud V., Lauré F., Brossard A., Bignozzi C., Goudeau A., Barin F., Bréchot C. Frequent and early in utero HIV-1 infection. AIDS Res Hum Retroviruses. 1991 Mar;7(3):337–341. doi: 10.1089/aid.1991.7.337. [DOI] [PubMed] [Google Scholar]
  12. Couvreur J., Desmonts G., Tournier G., Szusterkac M. Etude d'une série homogène de 210 cas de toxoplasmose congénitale chez des nourrissons âgés de 0 à 11 mois et dépistés de facon prospective. Ann Pediatr (Paris) 1984 Nov;31(10):815–819. [PubMed] [Google Scholar]
  13. Couvreur J., Thulliez P., Daffos F., Aufrant C., Bompard Y., Gesquière A., Desmonts G. Foetopathie toxoplasmique. Traitement in utero par l'association pyriméthamine-sulfamides. Arch Fr Pediatr. 1991 Jun-Jul;48(6):397–403. [PubMed] [Google Scholar]
  14. Cradock-Watson J. E., Miller E., Ridehalgh M. K., Terry G. M., Ho-Terry L. Detection of rubella virus in fetal and placental tissues and in the throats of neonates after serologically confirmed rubella in pregnancy. Prenat Diagn. 1989 Feb;9(2):91–96. doi: 10.1002/pd.1970090203. [DOI] [PubMed] [Google Scholar]
  15. Cradock-Watson J. E., Ridehalgh M. K., Anderson M. J., Pattison J. R., Kangro H. O. Fetal infection resulting from maternal rubella after the first trimester of pregnancy. J Hyg (Lond) 1980 Dec;85(3):381–391. doi: 10.1017/s0022172400063452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Cuthbertson G., Weiner C. P., Giller R. H., Grose C. Prenatal diagnosis of second-trimester congenital varicella syndrome by virus-specific immunoglobulin M. J Pediatr. 1987 Oct;111(4):592–595. doi: 10.1016/s0022-3476(87)80128-2. [DOI] [PubMed] [Google Scholar]
  17. Daffos F., Forestier F., Capella-Pavlovsky M., Thulliez P., Aufrant C., Valenti D., Cox W. L. Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis. N Engl J Med. 1988 Feb 4;318(5):271–275. doi: 10.1056/NEJM198802043180502. [DOI] [PubMed] [Google Scholar]
  18. Derouin F., Thulliez P., Candolfi E., Daffos F., Forestier F. Early prenatal diagnosis of congenital toxoplasmosis using amniotic fluid samples and tissue culture. Eur J Clin Microbiol Infect Dis. 1988 Jun;7(3):423–425. doi: 10.1007/BF01962355. [DOI] [PubMed] [Google Scholar]
  19. Desmonts G., Couvreur J., Thulliez P. Toxoplasmose congénitale. Cinq cas de transmission à l'enfant d'une infection maternelle antérieure à la grossesse. Presse Med. 1990 Sep 29;19(31):1445–1449. [PubMed] [Google Scholar]
  20. Desmonts G., Couvreur J. Toxoplasmose congénitale. Etude prospective de l'issue de la grossesse chez 542 femmes atteintes de toxoplasmose acquise en cours de gestation. Ann Pediatr (Paris) 1984 Nov;31(10):805–809. [PubMed] [Google Scholar]
  21. Eggerding F. A., Peters J., Lee R. K., Inderlied C. B. Detection of rubella virus gene sequences by enzymatic amplification and direct sequencing of amplified DNA. J Clin Microbiol. 1991 May;29(5):945–952. doi: 10.1128/jcm.29.5.945-952.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Einsele H., Ehninger G., Steidle M., Vallbracht A., Müller M., Schmidt H., Saal J. G., Waller H. D., Müller C. A. Polymerase chain reaction to evaluate antiviral therapy for cytomegalovirus disease. Lancet. 1991 Nov 9;338(8776):1170–1172. doi: 10.1016/0140-6736(91)92032-w. [DOI] [PubMed] [Google Scholar]
  23. Enders G., Nickerl-Pacher U., Miller E., Cradock-Watson J. E. Outcome of confirmed periconceptional maternal rubella. Lancet. 1988 Jun 25;1(8600):1445–1447. doi: 10.1016/s0140-6736(88)92249-0. [DOI] [PubMed] [Google Scholar]
  24. Enders G. Varicella-zoster virus infection in pregnancy. Prog Med Virol. 1984;29:166–196. [PubMed] [Google Scholar]
  25. Fan-Havard P., Nahata M. C., Brady M. T. Ganciclovir--a review of pharmacology, therapeutic efficacy and potential use for treatment of congenital cytomegalovirus infections. J Clin Pharm Ther. 1989 Oct;14(5):329–340. doi: 10.1111/j.1365-2710.1989.tb00256.x. [DOI] [PubMed] [Google Scholar]
  26. Fowler K. B., Stagno S., Pass R. F., Britt W. J., Boll T. J., Alford C. A. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. N Engl J Med. 1992 Mar 5;326(10):663–667. doi: 10.1056/NEJM199203053261003. [DOI] [PubMed] [Google Scholar]
  27. Goedert J. J., Duliège A. M., Amos C. I., Felton S., Biggar R. J. High risk of HIV-1 infection for first-born twins. The International Registry of HIV-exposed Twins. Lancet. 1991 Dec 14;338(8781):1471–1475. doi: 10.1016/0140-6736(91)92297-f. [DOI] [PubMed] [Google Scholar]
  28. Grillner L., Forsgren M., Barr B., Böttiger M., Danielsson L., De Verdier C. Outcome of rubella during pregnancy with special reference to the 17th-24th weeks of gestation. Scand J Infect Dis. 1983;15(4):321–325. doi: 10.3109/inf.1983.15.issue-4.01. [DOI] [PubMed] [Google Scholar]
  29. Grover C. M., Thulliez P., Remington J. S., Boothroyd J. C. Rapid prenatal diagnosis of congenital Toxoplasma infection by using polymerase chain reaction and amniotic fluid. J Clin Microbiol. 1990 Oct;28(10):2297–2301. doi: 10.1128/jcm.28.10.2297-2301.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Gwinn M., Pappaioanou M., George J. R., Hannon W. H., Wasser S. C., Redus M. A., Hoff R., Grady G. F., Willoughby A., Novello A. C. Prevalence of HIV infection in childbearing women in the United States. Surveillance using newborn blood samples. JAMA. 1991 Apr 3;265(13):1704–1708. [PubMed] [Google Scholar]
  31. Harding B., Baumer J. A. Congenital varicella-zoster. A serologically proven case with necrotizing encephalitis and malformation. Acta Neuropathol. 1988;76(3):311–315. doi: 10.1007/BF00687781. [DOI] [PubMed] [Google Scholar]
  32. Herrmann K. L. Available rubella serologic tests. Rev Infect Dis. 1985 Mar-Apr;7 (Suppl 1):S108–S112. doi: 10.1093/clinids/7.supplement_1.s108. [DOI] [PubMed] [Google Scholar]
  33. Higa K., Dan K., Manabe H. Varicella-zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformations. Obstet Gynecol. 1987 Feb;69(2):214–222. [PubMed] [Google Scholar]
  34. Hohlfeld P., Daffos F., Thulliez P., Aufrant C., Couvreur J., MacAleese J., Descombey D., Forestier F. Fetal toxoplasmosis: outcome of pregnancy and infant follow-up after in utero treatment. J Pediatr. 1989 Nov;115(5 Pt 1):765–769. doi: 10.1016/s0022-3476(89)80660-2. [DOI] [PubMed] [Google Scholar]
  35. Hohlfeld P., Vial Y., Maillard-Brignon C., Vaudaux B., Fawer C. L. Cytomegalovirus fetal infection: prenatal diagnosis. Obstet Gynecol. 1991 Oct;78(4):615–618. [PubMed] [Google Scholar]
  36. Hornstein L., Levy U., Fogel A. Clinical rubella with virus transmission to the fetus in a pregnant woman considered to be immune. N Engl J Med. 1988 Nov 24;319(21):1415–1416. [PubMed] [Google Scholar]
  37. Humphrey W., Magoon M., O'Shaughnessy R. Severe nonimmune hydrops secondary to parvovirus B-19 infection: Spontaneous reversal in utero and survival of a term infant. Obstet Gynecol. 1991 Nov;78(5 Pt 2):900–902. [PubMed] [Google Scholar]
  38. Hutto C., Parks W. P., Lai S. H., Mastrucci M. T., Mitchell C., Munoz J., Trapido E., Master I. M., Scott G. B. A hospital-based prospective study of perinatal infection with human immunodeficiency virus type 1. J Pediatr. 1991 Mar;118(3):347–353. doi: 10.1016/s0022-3476(05)82145-6. [DOI] [PubMed] [Google Scholar]
  39. Isada N. B., Paar D. P., Johnson M. P., Evans M. I., Holzgreve W., Qureshi F., Straus S. E. In utero diagnosis of congenital varicella zoster virus infection by chorionic villus sampling and polymerase chain reaction. Am J Obstet Gynecol. 1991 Dec;165(6 Pt 1):1727–1730. doi: 10.1016/0002-9378(91)90023-k. [DOI] [PubMed] [Google Scholar]
  40. Lee S. H., Ewert D. P., Frederick P. D., Mascola L. Resurgence of congenital rubella syndrome in the 1990s. Report on missed opportunities and failed prevention policies among women of childbearing age. JAMA. 1992 May 20;267(19):2616–2620. [PubMed] [Google Scholar]
  41. Levin M. J., Oxman M. N., Moore M. G., Daniels J. B., Scheer K. Diagnosis of congenital rubella in utero. N Engl J Med. 1974 May 23;290(21):1187–1188. doi: 10.1056/NEJM197405232902108. [DOI] [PubMed] [Google Scholar]
  42. Lynch L., Daffos F., Emanuel D., Giovangrandi Y., Meisel R., Forestier F., Cathomas G., Berkowitz R. L. Prenatal diagnosis of fetal cytomegalovirus infection. Am J Obstet Gynecol. 1991 Sep;165(3):714–718. doi: 10.1016/0002-9378(91)90315-i. [DOI] [PubMed] [Google Scholar]
  43. Magliocco A. M., Demetrick D. J., Sarnat H. B., Hwang W. S. Varicella embryopathy. Arch Pathol Lab Med. 1992 Feb;116(2):181–186. [PubMed] [Google Scholar]
  44. Mano H., Chermann J. C. Fetal human immunodeficiency virus type 1 infection of different organs in the second trimester. AIDS Res Hum Retroviruses. 1991 Jan;7(1):83–88. doi: 10.1089/aid.1991.7.83. [DOI] [PubMed] [Google Scholar]
  45. Miller E., Cradock-Watson J. E., Pollock T. M. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet. 1982 Oct 9;2(8302):781–784. doi: 10.1016/s0140-6736(82)92677-0. [DOI] [PubMed] [Google Scholar]
  46. Minkoff H. L., Henderson C., Mendez H., Gail M. H., Holman S., Willoughby A., Goedett J. J., Rubinstein A., Stratton P., Walsh J. H. Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects. Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1598–1604. [PubMed] [Google Scholar]
  47. Mittelmann-Handwerker S., Pardes J. G., Post R. C., Sumala M., Rosenberg J. C., Chervenak F. A. Fetal ventriculomegaly and brain atrophy in a woman with intrauterine cytomegalovirus infection. A case report. J Reprod Med. 1986 Nov;31(11):1061–1064. [PubMed] [Google Scholar]
  48. Morey A. L., Nicolini U., Welch C. R., Economides D., Chamberlain P. F., Cohen B. J. Parvovirus B19 infection and transient fetal hydrops. Lancet. 1991 Feb 23;337(8739):496–496. doi: 10.1016/0140-6736(91)93435-c. [DOI] [PubMed] [Google Scholar]
  49. Munro N. D., Sheppard S., Smithells R. W., Holzel H., Jones G. Temporal relations between maternal rubella and congenital defects. Lancet. 1987 Jul 25;2(8552):201–204. doi: 10.1016/s0140-6736(87)90775-6. [DOI] [PubMed] [Google Scholar]
  50. Naides S. J., Weiner C. P. Antenatal diagnosis and palliative treatment of non-immune hydrops fetalis secondary to fetal parvovirus B19 infection. Prenat Diagn. 1989 Feb;9(2):105–114. doi: 10.1002/pd.1970090205. [DOI] [PubMed] [Google Scholar]
  51. Paryani S. G., Arvin A. M. Intrauterine infection with varicella-zoster virus after maternal varicella. N Engl J Med. 1986 Jun 12;314(24):1542–1546. doi: 10.1056/NEJM198606123142403. [DOI] [PubMed] [Google Scholar]
  52. Pletcher B. A., Williams M. K., Mulivor R. A., Barth D., Linder C., Rawlinson K. Intrauterine cytomegalovirus infection presenting as fetal meconium peritonitis. Obstet Gynecol. 1991 Nov;78(5 Pt 2):903–905. [PubMed] [Google Scholar]
  53. Porter H. J., Khong T. Y., Evans M. F., Chan V. T., Fleming K. A. Parvovirus as a cause of hydrops fetalis: detection by in situ DNA hybridisation. J Clin Pathol. 1988 Apr;41(4):381–383. doi: 10.1136/jcp.41.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Porter H. J., Quantrill A. M., Fleming K. A. B19 parvovirus infection of myocardial cells. Lancet. 1988 Mar 5;1(8584):535–536. doi: 10.1016/s0140-6736(88)91332-3. [DOI] [PubMed] [Google Scholar]
  55. Pretorius D. H., Hayward I., Jones K. L., Stamm E. Sonographic evaluation of pregnancies with maternal varicella infection. J Ultrasound Med. 1992 Sep;11(9):459–463. doi: 10.7863/jum.1992.11.9.459. [DOI] [PubMed] [Google Scholar]
  56. Pryde P. G., Nugent C. E., Pridjian G., Barr M., Jr, Faix R. G. Spontaneous resolution of nonimmune hydrops fetalis secondary to human parvovirus B19 infection. Obstet Gynecol. 1992 May;79(5 ):859–861. [PubMed] [Google Scholar]
  57. Salzman M. B., Sood S. K. Congenital anomalies resulting from maternal varicella at 25 1/2 weeks of gestation. Pediatr Infect Dis J. 1992 Jun;11(6):504–505. doi: 10.1097/00006454-199206000-00023. [DOI] [PubMed] [Google Scholar]
  58. Scharf A., Scherr O., Enders G., Helftenbein E. Virus detection in the fetal tissue of a premature delivery with a congenital varicella syndrome. A case report. J Perinat Med. 1990;18(4):317–322. [PubMed] [Google Scholar]
  59. Schwarz T. F., Nerlich A., Hottenträger B., Jäger G., Wiest I., Kantimm S., Roggendorf H., Schultz M., Gloning K. P., Schramm T. Parvovirus B19 infection of the fetus. Histology and in situ hybridization. Am J Clin Pathol. 1991 Jul;96(1):121–126. doi: 10.1093/ajcp/96.1.121. [DOI] [PubMed] [Google Scholar]
  60. Sever J. L., Ellenberg J. H., Ley A. C., Madden D. L., Fuccillo D. A., Tzan N. R., Edmonds D. M. Toxoplasmosis: maternal and pediatric findings in 23,000 pregnancies. Pediatrics. 1988 Aug;82(2):181–192. [PubMed] [Google Scholar]
  61. Siegel M. Congenital malformations following chickenpox, measles, mumps, and hepatitis. Results of a cohort study. JAMA. 1973 Dec 24;226(13):1521–1524. [PubMed] [Google Scholar]
  62. Skvorc-Ranko R., Lavoie H., St-Denis P., Villeneuve R., Gagnon M., Chicoine R., Boucher M., Guimond J., Dontigny Y. Intrauterine diagnosis of cytomegalovirus and rubella infections by amniocentesis. CMAJ. 1991 Sep 15;145(6):649–654. [PMC free article] [PubMed] [Google Scholar]
  63. Sperling R. S., Stratton P. Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric-Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. Obstet Gynecol. 1992 Mar;79(3):443–448. doi: 10.1097/00006250-199203000-00024. [DOI] [PubMed] [Google Scholar]
  64. Stagno S., Pass R. F., Cloud G., Britt W. J., Henderson R. E., Walton P. D., Veren D. A., Page F., Alford C. A. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA. 1986 Oct 10;256(14):1904–1908. [PubMed] [Google Scholar]
  65. Terry G. M., Ho-Terry L., Warren R. C., Rodeck C. H., Cohen A., Rees K. R. First trimester prenatal diagnosis of congenital rubella: a laboratory investigation. Br Med J (Clin Res Ed) 1986 Apr 5;292(6525):930–933. doi: 10.1136/bmj.292.6525.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Török T. J. Human parvovirus B19 infections in pregnancy. Pediatr Infect Dis J. 1990 Oct;9(10):772–776. [PubMed] [Google Scholar]
  67. Török T. J., Wang Q. Y., Gary G. W., Jr, Yang C. F., Finch T. M., Anderson L. J. Prenatal diagnosis of intrauterine infection with parvovirus B19 by the polymerase chain reaction technique. Clin Infect Dis. 1992 Jan;14(1):149–155. doi: 10.1093/clinids/14.1.149. [DOI] [PubMed] [Google Scholar]
  68. Weiner C. P., Naides S. J. Fetal survival after human parvovirus B19 infection: spectrum of intrauterine response in a twin gestation. Am J Perinatol. 1992 Jan;9(1):66–68. doi: 10.1055/s-2007-994673. [DOI] [PubMed] [Google Scholar]

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