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Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 442-444
Human parvovirus B19 in Iranian pregnant women: A serologic survey

1 Department of Clinical Laboratory Sciences, School of Paramedicine, Urmia University of Medical Sciences, Urmia, Iran
2 Department of Epidemiology and Biostatistics, Urmia University of Medical Sciences, Urmia, Iran

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Date of Web Publication14-Aug-2014


Background: Parvovirus B19 infection is associated with clinical symptoms that vary in the spectrum from trivial to severe. The important clinical manifestations are erythema infectiosum or the fifth disease, transient aplastic anemia in patients with hemoglobinopathies, acute polyarthralgia syndrome in adults, hydrops fetalis, spontaneous abortion and stillbirth. Acute infection in nonimmune pregnant women can lead to fetal hydrops. In view of the many complications that can result from acute parvovirus B19 infections during pregnancy, documenting the seroprevalence of anti-parvovirus B19 IgG and its association with the history of abortion in an Iranian population of pregnant women would be of value. Materials and Methods: Serum samples from 86 pregnant women were collected between May and September 2011 in West Azerbaijan province of Iran. Every pregnant woman completed a questionnaire which included age, history of tattooing, blood transfusion, and abortion. Anti-B19 specific IgG was detected by using commercial enzyme-linked immunosorbent assays. Results: Anti-B19-specific IgG antibody was detected in (65/86, 75.6%) of pregnant women. The mean age was 25.56 ± 5.30 years and three women had a documented history of blood transfusion (2 of them tested seropositive for B19). 16/18 (88.8%) of women with a history of abortion were IgG positive. The frequency of abortion sessions in the seropositive group (25 sessions of abortion: 11 women experienced once, 2 twice, 2 thrice and one 4 times) was 4.03 times greater than abortion in seronegative group (2 abortions/21 seronegative women). Conclusion: Our study reaffirms previous reports regarding the higher frequency of abortion among anti-B19 IgG seropositive pregnant women and a possible role of this viral infection in the pathogenesis of abortion.

Keywords: Enzyme-linked immunosorbent assays, IgG, parvovirus B19, pregnancy, serology

How to cite this article:
Khameneh ZR, Hanifian H, Barzegari R, Sepehrvand N. Human parvovirus B19 in Iranian pregnant women: A serologic survey. Indian J Pathol Microbiol 2014;57:442-4

How to cite this URL:
Khameneh ZR, Hanifian H, Barzegari R, Sepehrvand N. Human parvovirus B19 in Iranian pregnant women: A serologic survey. Indian J Pathol Microbiol [serial online] 2014 [cited 2022 Jan 20];57:442-4. Available from: https://www.ijpmonline.org/text.asp?2014/57/3/442/138748

   Introduction Top

Parvovirus B19 is a member of the Parvoviridae family, genus Erythrovirus. It is a naked single-stranded DNA virus and the only known human pathogenic parvovirus. [1] Its genome of about 2500 base pairs encodes for three major proteins. Two structural proteins (VP1 and VP2) make up the viral capsid, [2] and the nonstructural protein (NS1) is presumed to be involved in viral replication, activation of viral gene transcription and inducing apoptosis in target cells. [3]

The infection usually occurs in childhood and the most frequent manifestation of parvovirus B19 infection is erythema infectiosum, also called the fifth disease or "slapped-cheek" disease. [4] However, it can cause a wide variety of clinical manifestations. Since the virus replicates within the nucleus of erythroid precursor cells, the infection is lytic, and it causes a transient cessation of red blood cell production, so it leads to transient aplastic crisis, especially in persons with underlying hemolytic disorders. [5],[6]

The virus usually distributes through respiratory droplets; recurrent blood transfusions and immunosuppression are also risk factors for B19 virus infection. Fetal loss results from fetal red blood cell destruction in nonimmune pregnant women. [1]

Infection by parvovirus during pregnancy is not associated with increased risk of fetal malformation. However, infection during pregnancy is an important cause of intrauterine fetal death, stillbirth, and nonimmune hydrops fetalis. [7]

There is a paucity of data regarding the incidence, prevalence and outcomes of B19 infection in Iran; however, we aimed to study the seropositivity of anti-parvovirus B19 IgG in a group of Iranian pregnant women and its association with a previous history of abortion.

   Materials and methods Top

This cross-sectional study was implemented following approval of Scientific and Ethical Review Board of Urmia University of Medical Sciences, Iran. Eighty-six pregnant women were selected randomly from all districts of Urmia city in West Azerbaijan in consonance with a population of each district. A questionnaire was filled by every participant including demographic information as well as history of tattooing, blood transfusion or any previous abortion or stillbirth. A volume of 5 mL blood sample was collected through venipuncture and serum samples were separated and stored at –20 until testing. Sampling was done between May and September 2011.

Anti-parvovirus B19 IgG was measured by a commercial enzyme-linked immunosorbant assay (Diapro, Italy). The procedure and interpretation of results was carried out as per kit protocol.

All data were analyzed by SPSS statistical software version 16 (SPSS Inc. Chicago, IL). P < 0.05 was considered statistically significant.

   Results Top

Eighty-six pregnant women were enrolled randomly in this study, which was aimed to investigate the risk of parvovirus infection among pregnant women and its association with a history of abortion. The mean age was 25.56 ± 5.30 years.

Anti-B19-specific IgG antibodies were detected in 65/86 (75.6%) of pregnant women. Two of three women who had a previous history of blood transfusion tested seropositive for B19. 16/18 (88.8%) of all women who had a documented history of abortion tested positive for IgG.

As statistically documented, it is clear that the frequency of abortion sessions in anti-parvovirus B19 IgG positive women (overall 25 events: 11 women experienced once, two twice, 2 thrice and one for 4 times) was 4.03 times more than the seronegative group (only 2 abortion events amongst 21 pregnancies).

The various differences between seronegative and seropositive groups are as shown in [Table 1]. As can be seen, anti-B19 IgG seropositive cases were significantly older than the seronegative ones (26.6 ± 5.2 vs. 22.3 ± 3.8; P = 0.04).
Table 1: Comparison of the characteristics between seronegative and seropositive groups for antiparvovirus B19 IgG

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   Discussion Top

Most parvovirus B19 infections occur in childhood: 40-50% of children and adolescents have anti-B19 specific IgG antibody as a sign of old B19 infection. Since adults are also infected, the rate of seropositivity in the population rises to around 60-70% in 20-30 years old, and 80% in 60-70 years old. According to the reports, 28% of women in reproductive ages in the USA and 81% in Sweden were immune to parvovirus B19. [8],[9]

For susceptible pregnant women, the risk of infection is high during epidemics and is associated with the level of contact with children. Most infections during pregnancy are due to a woman's exposure to her own children. [10] Half of the cases with parvovirus infection tend to be asymptomatic. [3]

Chisaka et al. studied 478 women with suspected B19 infection. 21% of them were positive for anti-B19 specific IgM and IgG. Overall, incidence of adverse fetal effects (including hydrops fetalis and fetal death) related to intrauterine B19 infection was 7%. [3]

On the contrary, few studies are not in favor of the role of parvovirus B19 as a cause for fetal loss. According to the Johansson et al., parvovirus viremia was associated with adjusted odds ratio of 3.76 for second trimester miscarriage, [11] but by considering the 95% confidence interval provided for the odds ratio (0.77-18.3), we can see that the association is not statistically significant. Another study by Odland et al. on the sera of two groups of normal pregnant women and recurrent abborters from Russia, failed to find any correlation between parvovirus B19 infection and recurrent abortion. [12]

A large number of studies have buttressed the idea of potential correlation between parvovirus B19 infection during pregnancy and fetal loss. The study of Xu et al. demonstrated that 27.3% of spontaneous abortion tissues were positive for parvovirus B19-DNA, but this rate was only 4% in the control group (healthy women with artificial abortion). [13] Yaegashi et al. have reported the rate of fetal death in women infected with B19 during pregnancy to be 15%, which was far higher than the rate in the general population (1%). [14] Wang et al. have found parvovirus B19 DNA in 26% of subjects with spontaneous abortions as compared with 5% of subjects in the control group. [15] Tolfvenstam et al. have reported that 15% of cases of intrauterine fetal deaths were positive for parvovirus B19 in fetal or placental tissues or both. [8]

The only previous report from Iran failed to find any correlation between B19 seropositivity (IgG and IgM) and the unsuccessful pregnancy outcome. [16] In our study, we found the history of abortion to be higher among B19 seropositive cases compared to the seronegative ones. Furthermore, the number of abortions was 4 times greater in the seropositive group compared to the seronegative group.

In this study, we had not tested for the antiparvovirus IgM antibody, hence drawing any conclusion on the presence of infection during pregnancy was not possible.

According to Crane in the presence of parvovirus B19 IgG and absence of IgM, the woman is immune and can be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. [17] However, in the study of Nyman et al. in Sweden 3% (36 cases) of first-trimester fetal losses, were B19 DNA positive, but in serologic study, they were seropositive for IgG and seronegative for anti-B19 IgM. [18] It seems that the reliable diagnosis of B19 virus infection should be based on parvovirus B19 DNA detection. [7]

In the current study, any of subjects (even who had a previous history of recurrent abortion) have not been screened for TORCH, or Chlamydia trachomatis infections, anatomical, chromosomal, endocrinal abnormalities, or for Rh incompatibility. The authors recommend that these factors be taken into consideration in future studies.

   Acknowledgments Top

The authors would like to thank Research Committee of Urmia University of Medical Sciences for financial support for this work.

   References Top

de Jong EP, Walther FJ, Kroes AC, Oepkes D. Parvovirus B19 infection in pregnancy: New insights and management. Prenat Diagn 2011;31:419-25.  Back to cited text no. 1
Kaufmann B, Simpson AA, Rossmann MG. The structure of human parvovirus B19. Proc Natl Acad Sci U S A 2004;101:11628-33.  Back to cited text no. 2
Chisaka H, Ito K, Niikura H, Sugawara J, Takano T, Murakami T, et al. Clinical manifestations and outcomes of parvovirus B19 infection during pregnancy in Japan. Tohoku J Exp Med 2006;209:277-83.  Back to cited text no. 3
Dijkmans AC, de Jong EP, Dijkmans BA, Lopriore E, Vossen A, Walther FJ, et al. Parvovirus B19 in pregnancy: Prenatal diagnosis and management of fetal complications. Curr Opin Obstet Gynecol 2012;24:95-101.  Back to cited text no. 4
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. J Intern Med 2006;260:285-304.  Back to cited text no. 5
Syridou G, Spanakis N, Konstantinidou A, Piperaki ET, Kafetzis D, Patsouris E, et al. Detection of cytomegalovirus, parvovirus B19 and herpes simplex viruses in cases of intrauterine fetal death: Association with pathological findings. J Med Virol 2008;80:1776-82.  Back to cited text no. 6
Eis-Hübinger AM, Dieck D, Schild R, Hansmann M, Schneweis KE. Parvovirus B19 infection in pregnancy. Intervirology 1998;41:178-84.  Back to cited text no. 7
Tolfvenstam T, Papadogiannakis N, Norbeck O, Petersson K, Broliden K. Frequency of human parvovirus B19 infection in intrauterine fetal death. Lancet 2001;357:1494-7.  Back to cited text no. 8
Xu J, Raff TC, Muallem NS, Neubert AG. Hydrops fetalis secondary to parvovirus B19 infections. J Am Board Fam Pract 2003;16:63-8.  Back to cited text no. 9
Modrow S, Gärtner B. Parvovirus B19 infection in pregnancy. Dtsch Arztebl 2006;103:A 2869-76.  Back to cited text no. 10
Johansson S, Buchmayer S, Harlid S, Iliadou A, Sjöholm M, Grillner L, et al. Infection with parvovirus B19 and herpes viruses in early pregnancy and risk of second trimester miscarriage or very preterm birth. Reprod Toxicol 2008;26:298-302.  Back to cited text no. 11
Odland JØ, Sergejeva IV, Ivaneev MD, Jensen IP, Stray-Pedersen B. Seropositivity of cytomegalovirus, parvovirus and rubella in pregnant women and recurrent aborters in Leningrad county, Russia. Acta Obstet Gynecol Scand 2001;80:1025-9.  Back to cited text no. 12
Xu D, Zhang G, Wang R. The study on detection of human parvovirus B19 DNA in spontaneous abortion tissuess. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 1998;12:158-60.  Back to cited text no. 13
Yaegashi N, Niinuma T, Chisaka H, Uehara S, Okamura K, Shinkawa O, et al. Serologic study of human parvovirus B19 infection in pregnancy in Japan. J Infect 1999;38:30-5.  Back to cited text no. 14
Wang R, Chen X, Han M. Relationship between human parvovirus B19 infection and spontaneous abortions. Zhonghua Fu Chan Ke Za Zhi 1997;32:541-3.  Back to cited text no. 15
Saeedi M, Moradi A, Ghaemi E, Bakhshandeh Nosrat S. Seroepidemiology of parvovirus B19 in successful and unsuccessful pregnancy. In: 9 th Annual Iranian Congress of Immunology, Asthma & Allergy. Tehran: Iranian J Public Health; 2008.  Back to cited text no. 16
Crane J, Society of Obstetricians and Gynaecologists of Canada. Parvovirsus B19 infection in pregnancy. J Obstet Gynaecol Can 2002;24:727-43.  Back to cited text no. 17
Nyman M, Tolfvenstam T, Petersson K, Krassny C, Skjöldebrand-Sparre L, Broliden K. Detection of human parvovirus B19 infection in first-trimester fetal loss. Obstet Gynecol 2002;99:795-8.  Back to cited text no. 18

Correspondence Address:
Nariman Sepehrvand
Deputy for Research Affairs, Urmia University of Medical Sciences, Resalat Avenue, Djahad Square, Urmia, West-Azerbaijan
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Source of Support: Urmia University of Medical Sciences, Conflict of Interest: None

DOI: 10.4103/0377-4929.138748

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