City Research Online

Abstract

Congenital cytomegalovirus (cCMV) infection causes significant morbidity and can be a result of primary or non-primary maternal HCMV infection. Diagnosing non-primary maternal infection in human cytomegalovirus (HCMV)-seropositive pregnant women is challenging. It is possible that detection of HCMV shedding in the bodily fluids of HCMVseropositive pregnant women may aid in identifying those with non-primary infection. This hypothesis was examined using two, complementary, methodologies: a systematic review to understand the prevalence of HCMV shedding in HCMV-seropositive pregnant women, and an observational cohort study. The observational cohort study investigated the prevalence and risk factors of HCMV shedding, the HCMV-specific cellular mediated immunity (CMI), the hygiene-related contact with children’s bodily fluids, and the experiences of participating in a study, in HCMV-seropositive pregnant women. To achieve this, serial sampling of saliva, urine, vaginal secretions, and blood, alongside completion of questionnaires were performed, followed by an interview. The prevalence of HCMV shedding in any bodily fluids of HCMV-seropositive women at any point in pregnancy was approximately 20%, consistent with the estimate calculated from the systematic review. Risk of HCMV shedding during pregnancy was associated with lower number of pregnancies. An HCMV-enzyme-linked immunosorbent spot (ELISPOT) assay, specifically the responses towards the phosphoprotein(pp) 65 antigen, was more likely to detect HCMV-specific CMI during pregnancy and identified that a lower response to pp65 was associated with a higher likelihood of HCMV shedding. Most hygiene-related contact with children’s bodily fluids was not found to be associated with HCMV shedding. Study participation during pregnancy in women with children was shown to be feasible, although reducing involvement around the time of birth would improve study compliance and experience. In conclusion, HCMV shedding in HCMV-seropositive women during pregnancy, may be used as an endpoint for the evaluation of preventative and therapeutic strategies against maternal and cCMV infection.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > Q Science (General) R Medicine > R Medicine (General) R Medicine > RB Pathology
Departments:	School of Health & Medical Sciences > Infection and Immunity Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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