Prevalence of Cytomegalovirus in First Trimesteric Spontaneous Abortion: A Prospective Serological and Molecular Case–control Study

Aim: To measure the prevalence and assess the risk of cytomegalovirus (CMV) infection in women diagnosed with first-trimester spontaneous abortion. Comparison Methods: This was a prospective case-control study; a total of 551 women were recruited from two Maternity and Children Hospitals (Makkah and Jeddah cities) in the Western province of the kingdom between March 2013 and June 2016 Serum and products of conceptions were collected prospectively from 201 women diagnosed with first-trimester spontaneous abortion. Another set of serum samples and placental tissues were collected from 350 healthy pregnant women at the time of normal vaginal delivery. CMV IgM and IgG antibodies were measured serologically by ELISA while viral DNA was detected in tissue specimens by PCR. Socio-economic data were analysed to identify potential risk factors of abortion and/or CMV infection. Results: The overall prevalence was 88.4%, 13.6% and 10.1%, for IgG+, IgM+ and PCR+, respectively. IgG+ frequency was comparable between cases (89%) and controls (88%). Both exclusively IgM+ (7.9% vs. 0.6%) and dual IgM+/IgG+ (22.4% vs. 3.4%) antibodies were significantly more prevalent in abortion (P < 0.01). PCR+ was also significantly higher (P < 0.01) in abortion (25.4% vs. 1.4%). Women with exclusive IgM+ (OR 17.1; 95%CI [3.38 – 86.68]; P = 0.001) and those who were positive for all tests (OR 29.3; 95%CI [6.52–131.71]; P < 0.001) had a significantly increased risk for abortion. Conclusions: The majority of the study sample of pregnant women in Saudi Arabia were previously exposed to CMV. First trimester CMV infection appears to be an independent risk for spontaneous abortion and viral spread to the intrauterine cavity was associated with the highest risk for miscarriage. More studies are required to measure the precise prevalence of CMV and its associated sequelae during pregnancy in the kingdom.