Diagnostic value of alpha-fetoprotein in the implementation of non-immune fetal hydrops due to parvovirus b19 infection during pregnancy
Keywords:parvovirus В19 infection during pregnancy, non-immune fetal hydrops, α-fetoprotein
Background. Intrauterine infection remains the main problem of perinatology. Early diagnosis of such infection causes enough difficulties and requires improvement. This study is devoted to the problem of predicting non-immune fetal hydrops if a woman is infected with parvovirus B19 in the II trimester of pregnancy.
Objectives: to improve the diagnosis of non-immune fetal hydrops on the basis of changes in the α-fetoprotein (AFP) value in maternal blood during parvovirus B19 infection .
Materials and methods. Serial AFP determination in blood serum of pregnant women infected with parvovirus B19 (n = 16) at 18–20–22 weeks of pregnancy was carried out. Biochemical analysis of AFP in amniotic fluid was performed after prenatal invasive examination in fetuses with non-immune hydrops. The obtained data were compared with similar indicators of pregnant women from the control group (n = 16) with a normal course of pregnancy in the II trimester. Transabdominal amniocentesis was performed under ultrasound control at 16–20 weeks of gestation for fetuses with non-immune hydrops. Determination of the AFP value in the blood serum of pregnant women in the II trimester was performed with a chemiluminescence immunoassay analyzer.
Results. It was established that the AFP level in maternal blood reaches and exceeds threshold values (2.6 ± 0.05 MoM) on average 2.5 ± 0.5 weeks before the manifestation of severe fetal anemia in infected fetus with non-immune hydrops (r = 0.768, p < 0.001). That is, a sharp AFP increase in the blood of a pregnant woman infected with parvovirus B19 is a predictor of the development of non-immune fetal hydrops due to parvovirus B19 infection.
Conclusions. The described method has proven to be highly effective, it is allows reducing the frequency of ultrasound examinations for infected women, because the fetus is not always infected from an infected mother. This technique can be used as a predictor of intrauterine parvovirus B19 infection in the II trimester, which will allow the development of new approaches to the early diagnosis of non-immune fetal hydrops, as well as contribute to timely intrauterine hemotransfusion.
- Agrawal, V., Hirsch, E. “Intrauterine infection and preterm labor.” Semin Fetal Neonatal Med 17.1 (2012): 12–9. DOI: 10.1016/j.siny.2011.09.001
- Karabulut, A., Gok, S. “Non-immune hydrops fetalis without anemia due to parvovirus B19.” Int J Gynecol Obstet 124 (2014): 82.
- Badeau, M., Lindsay, C., Blais, J., et al. “Genomics-based non-invasive prenatal testing for detection of fetal chromosomal aneuploidy in pregnant women.” Cochrane Database Syst Rev 11 (2017): CD011767. DOI: 10.1002/14651858.CD011767.pub2
- Barlinn, R., Vainio, K., Samdal, H.H., et al. “Susceptibility to cytomegalovirus, parvovirus B19 and age-dependent differences in levels of rubella antibodies among pregnant women.” J Med Virol 86.5 (2014): 820–6. DOI: 10.1002/jmv.23757
- Bellini, C., Donarini, G., Paladini, D., et al. “Etiology of non-immune hydrops fetalis: an update.” Am J Med Genet A 167A.5 (2015): 1082–8. DOI: 10.1002/ajmg.a.36988
- Bredaki, F.E., Matalliotakis, M., Wright, A., et al. “Maternal serum alpha-fetoprotein at 12, 22 and 32 weeks’ gestation in screening for pre-eclampsia.” Ultrasound Obstet Gynecol 47 (2016): 466–71. DOI: 10.1002/uog.15818
- Chen, T., Lundin, E., Grankvist, K., et al. “Maternal hormones during early pregnancy: a cross-sectional study.” Cancer Causes Control 21.5 (2010): 719–27. DOI: 10.1007/s10552-009-9500-2
- Chen, Y., Wu, B., Chen, Y., et al. “A Risk Model for Predicting Fetuses with Trisomy 21 Using Alpha-Fetoprotein Variants L2 Combined with Maternal Serum Biomarkers in Early Pregnancy.” Reprod Sci 29.4 (2022): 1287–95. DOI: 10.1007/s43032-021-00762-5
- Conti, E., Zezza, L., Ralli, E., et al. “Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards?” Cytokine Growth Factor Rev 24.5 (2013): 411–25. DOI: 10.1016/j.cytogfr.2013.05.008
- Martinez-Payo, C., Bernabeu, R.A., Villar, I.S., Goy, E.I. “Intrauterine Growth Restriction Associated with Hematologic Abnormalities: Probable Manifestations of Placental Mesenchymal Dysplasia.” AJP Rep 5.2 (2015): e085–e088. DOI: 10.1055/s-0034-1394152
- Darouich, A.A., Liehr, T., Weise, A., et al. “Alpha-fetoprotein and its value for predicting pregnancy outcomes – a re-evaluation.” J Prenat Med 9.3–4 (2015): 18–23.
- Dijkmans, A.C., de Jong, E.P., Dijkmans, B.A., et al. “Parvovirus B19 in pregnancy: prenatal diagnosis and management of fetal complications.” Curr Opin Obstet Gynecol 24.2 (2012): 95–101. DOI: 10.1097/GCO.0b013e3283505a9d
- Fettke, F., Schumacher, A., Canellada, A., Toledo, N., et al. “Maternal and Fetal Mechanisms of B Cell Regulation during Pregnancy: Human Chorionic Gonadotropin Stimulates B Cells to Produce IL-10 While Alpha-Fetoprotein Drives Them into Apoptosis.” Front Immunol 7 (2016): 495. DOI 10.3389/fimmu.2016.00495
- Aboughalia, H., Bastawrous, S., Revzin, M.V., et al. “Imaging findings in association with altered maternal alphafetoprotein levels during pregnancy.” Abdom Radiol (NY) 45.10 (2020): 3239–57. DOI: 10.1007/s00261-020-02499-2
- Karabulut, A. “Non-immune hydrops fetalis without anemia due to parvovirus B19.” Obstet Gynecol 124.1 (2014): 82.
- Lee, S.M., Romero, R., Park, J.S., et al. “A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes.” J Perinat Med 43.4 (2015): 381–9. DOI: 10.1515/jpm-2014-0276
- Zajkowska, A., Garkowski, A., Czupryna, P. “Seroprevalence of parvovirus B19 antibodies among young pregnant women or planning pregnancy, tested for toxoplasmosis.” Przegl Epidemiol 69.3 (2015): 479–82, 597–600.
- Reischer, T., Muth, B., Catic, A., et al. “Clinical Course and Outcome of Non-Immune Fetal Hydrops in Singleton Pregnancies.” J Clin Med 11.3 (2022): 702. DOI: 10.3390/jcm11030702
- Schumacher, A., Costa, S.D., Zenclussen, A.C. “Endocrine factors modulating immune responses in pregnancy.” Front Immunol 8.5 (2014): 196. DOI: 10.3389/fimmu.2014.00196
- Srinivasan, B., Finkelstein, J.L., Erickson, D., Mehta, S. “Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study.” JMIR Biomed Eng 6.1 (2021): e23527. DOI: 10.2196/23527
- Sun, W., Liu, B., Chen, J., et al. “Novel characteristics of alpha-fetoprotein (AFP)-producing gastric cancer.” Oncotarget 8.60 (2017): 101944–51. DOI: 10.18632/oncotarget.22109
- Torricelli, M., Voltolini, C., De Bonis, M., et al. “The identification of high risk pregnancy: a new challenge in obstetrics.” J Matern Fetal Neonatal Med 25.1 (2012): 2–5. DOI: 10.3109/14767058.2012.664355
- Wang, J., Zhang, P., Liao, J., et al. “Association of α-fetoprotein levels with liver stiffness measurement in outpatients with chronic hepatitis B.” Biosci Rep 41.1 (2021): BSR20203048. DOI: 10.1042/BSR20203048
- Xiao, J.P., Yin, Y.X., Gao, Y.F., et al. “The increased maternal serum levels of IL-6 are associated with the severity and onset of preeclampsia.” Cytokine 60.3 (2012): 856–60. DOI: 10.1016/j.cyto.2012.07.039
- Ji, Y., Song, B., Chen, S., et al. “Fetus in Fetu in the Scrotal Sac: Case Report and Literature Review.” Medicine (Baltimore) 94.32 (2015): e1322. DOI: 10.1097/MD.0000000000001322
- Ling, Y., Yu, Y.-H., Jin, S., et al. “Study of concentration of amniotic fluid alfa-fetal protein inthalassemia fetus.” Аsian Pac J Trop Med 10.2 (2017): 201–3. DOI: 10.1016/j.apjtm.2017.01.001
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