Local immunity in Indian women with bacterial vaginosis.

OBJECTIVES: To determine the immunoglobulin (Ig) and cytokine levels and degradation of Igs in the cervico-vaginal secretions (CVS) of non-pregnant Indian women of low socio economic status (LSES), with/without bacterial vaginosis (BV) and to assess the interactions among nutritional status, BV and local immunity. METHODS: A descriptive study in non-pregnant women of LSES attending the gynecology out patient clinic at a local government hospital, Hyderabad, India. Two hundred non-pregnant women underwent clinical, anthropometrical and gynecological examination and were screened for BV. In a sub-sample of 80 with/without BV, levels of IL-10 and IL-12, IgA, IgM and IgG were determined in the CVS by ELISA and degradation of IgA and IgM by Western blotting. Statistical significance among the groups was tested using the non-parametric Mann-Whitney U-test. RESULTS: Fifty seven percent of the women tested positive for BV. Women with BMI<16.0 had the highest BV positivity and the lowest IgA levels in CVS. Higher levels of IgA were observed in women with BMI>18.5. There was significant degradation of IgA and IgM in women with BV. IL-12 was undetectable while IL-10 was detected with higher means in CVS of women with BV. CONCLUSIONS: Severe under-nutrition appears to be relevant to BV positivity and local immunity in these women. Greater degradation of IgA and IgM in BV suggests impaired local immunity.

Socioeconomic status and prevalence of toxoplasmosis during pregnancy.

Two hundred and thirty-six women with previous bad obstetric history (BOH), belonging to different socio-economic groups were investigated for the presence of Toxoplasma specific antibodies (IgG/IgM) using commercial diagnostic kits. The study showed a higher percentage of IgG seropositivity in women of low socioeconomic group (LSG) compared to those of high socioeconomic group (HSG). Specific IgM positivity indicative of possible acute infection, was higher in women of HSG, emphasizing the need for educating pregnant mothers on preventive measures. However, there is a need to undertake in-depth studies to understand the significance of the presence of IgM in women with BOH.

Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy.

One hundred and seventy five apparently normal asymptomatic pregnant women were studied prospectively and 247 women with different complications of pregnancy were screened at the time of delivery for infections like Chlamydia trachomatis, Toxoplasma, Rubella and cytomegalovirus (CMV). One hundred and forty two women with normal outcome of pregnancy served as controls. Specific IgM due to these agents were determined in the sera using commercial diagnostic kits. Results of the study showed that chlamydial infection was the most prevalent (29.8%) followed by Toxoplasmosis (13.1), Rubella (6.5%) and CMV (5.8%). Adverse outcome was seen among those seropositive for Chlamydia, Toxoplasmosis and Rubella. CMV showed no association with adverse outcome of pregnancy. Since Chlamydia and Toxoplasmosis are amenable to treatment with antibiotics, screening for these infections and appropriate treatment would improve outcome of pregnancy.

A new approach to differentiate recent vs chronic Toxoplasma infection: avidity ELISA in Toxoplasma serology.

The diagnosis of toxoplamosis during pregnancy is based on maternal serology, due to the asymptomatic nature of the disease. Detection of specific IgM although is the method used all over the world to detect acute infection, persistence of IgM for long periods poses problems in distinguishing acute from chronic infection, which is of crucial importance in pregnancy. Avidity ELISA is a method recently developed to distinguish IgG antibodies developed at an early stage of infection from those that reflect past immunity. The avidity assay uses protein-denaturing agents and is a modification of an ELISA. The usefulness of this technique was tested on sera of 113 pregnant women screened for Toxoplasma specific IgG/IgM antibodies. Nine of the sixteen sera positive for IgM/IgG antibodies and three sera positive for IgG alone were subjected to avidity ELISA. Only three sera were positive for low avidity IgG indicative of recent infection. All the three sera positive for IgG alone showed high avidity.

Hyperferritinemia in pregnancy induced hypertension and eclampsia.

A study of serum iron and ferritin levels in Indian women with pregnancy induced hypertension (PIH) (mild/severe) and eclampsia compared with controls of similar gestational ages, revealed that mean serum iron was elevated slightly in PIH and significantly in eclampsia as compared to controls. Mean ferritin levels were significantly elevated both in PIH and eclampsia as compared to controls indicating that ferritin measurement in PIH and eclampsia would not reflect iron nutritional status. Lack of significant changes in liver enzymes and in hemoconcentration in PIH and eclampsia indicate that liver damage and altered hemodynamics only play a partial role in causing hyperferritinemia. Possible role of placental ferritin, being released as a result of placental damage in these conditions seems to be an area needing further research.

Effect of vitamin A supplementation on haemoglobin and vitamin A levels during pregnancy.

About 450 pregnant women from a low-income group were recruited to study the effect of vitamin A supplementation on plasma vitamin A levels in the mother and cord and on the birth weights of the neonates. Results showed that supplementation with 1800 micrograms vitamin A/d for more than 12 weeks prevented the decline in plasma vitamin A that otherwise occurs during the last few weeks of pregnancy. This improvement in maternal values for vitamin A at a critical time of development favourably affected availability to the fetus, as reflected by the marked elevation in cord levels. Supplementation for a period of 12 weeks was found to be sufficient, since subsequent discontinuation did not alter the beneficial response. Apart from increasing maternal and cord vitamin A levels, vitamin A supplementation along with iron prevented, in this study, the significant decline in haemoglobin occurring at 26-28 weeks of gestation. The birth weights were not altered by vitamin A supplementation.