Prospective study on maternal, intrauterine, and perinatal infections with cytomegalovirus in Japan during 1976-1990

Since 1976, sera obtained serially from 10,218 pregnant women during the first, second, and third trimesters of gestation and cord sera were tested for CMV complement-fixing (CF) and immunofluorescent (IF) antibodies. CMV IgG-IF antibody was positive in 9,735/10,218 (95%) in the first trimester, and a significant rise of CF antibodies during pregnancy was found in 70/9,206 (0.76%) of the seropositive group and in 5/438 (1.14%) of the seronegative group. IgM antibody was found in 6/9,206 (0.06%) of seropositive women during the first trimester and in 7/70 (10.0%) of seropositive mothers with CF antibody rise and in 4/5 of seroconverted mothers of the seronegative group, suggesting that the incidence of primary infection with CMV during pregnancy was approximately 1% of susceptible women. All the mothers with immune response had infants with neither viruria nor IgM antibody in the cord blood, whereas seropositive mothers without an immune response had infants with viruria (7/1,826; 0.4%) or with IgM antibody in the cord blood (6/9,136; 0.06%). None of these 13 babies, shedding CMV or with IgM IF antibody, had physical or mental retardation. CMV IgG-IF antibody was present in almost 80% of infants between 7 and 12 months of age in 1988, suggesting that perinatal or postnatal CMV infection may occur in infants born to seropositive mothers in 70-80% of pregnancies.

[The concentration of serum unconjugated estradiol, estriol and estetrol in pregnant women, and the significance of these hormones in pregnancy (author's transl)]

Simultaneous determinations of unconjugated estradiol (E2), estriol (E3) and 15 alpha-hydroxyestriol (E4) levels in maternal serum were studied serially to ascertain the significance of these estrogens in the feto-placental unit. The samples of serum were collected serially from 25 normal and 44 abnormal pregnancies. In normal pregnancy, these estrogen levels increased throughout pregnancy, especially E3 and E4 nearing the term. In 15 cases of IUGR pregnancy (including 4 cases of perinatal death), E2 levels were mostly low (less than M -- S.D.), E3 was within normal limits (M +/- S.D.) or low, and E4 was either high (greater than M + S.D.) or relatively low, and normal. In 9 cases of twin pregnancy, most E2 levels were within normal limits, while E3 and E4 were remarkedly high. The results signified that E2 indicated placental function, that E3 indicated placental and fetal function, and that E4 indicated fetal function.

[Concentration of serum unconjugated estriol and estetrol in pregnant women with intrauterine growth retardation, and significance of these hormones in pregnancy (author's transl)]

Recently, estetrol (15 alpha-hydroxyestriol, E4) has been suggested to be a better indicator of fetal well-being than estriol (E3). In normal pregnancy, the concentration of unconjugated E3 and E4 in serum gradually increased as pregnancy progressed, and especially, rapidly increased in the third trimester. The patients with IUGR were classified in three groups. In the first group with mild pregnancy complications or none, serum E3, E4 and urine E3 almost changed in normal range. In the second group with severe pregnancy complications, only serum E3 changed almost in normal range, but urine E3 shows in low levels and serum E4 in high levels. In the third group with perinatal death of neonate, these three hormone levels was remarkedly low, especially in serum and urine E3. The highest E3 value in 51 pregnant women, significantly correlated with placental weight, birth weight and body length of neonate, and highest E4 significantly correlated with birth weight and chest circumference of neonate. The results signified that E3 predominantly indicated placental function, E4 also fetal function.