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Difficulty in Serologic Screening for Subclinical Rubella during Pregnancy
Kazuya Hiiragi1, Ryosuke Shindo1, Satoru Shinoda2
1Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Japan.
Japanese Journal of Infectious Diseases
|November 29, 2023
Summary
Testing rubella antibodies in pregnant women in Japan using hemagglutination inhibition (HI) and IgM tests alone is insufficient for detecting subclinical rubella. Increased awareness can reduce anxiety and prevent unnecessary pregnancy terminations.
Area of Science:
- Immunology
- Public Health
- Obstetrics & Gynecology
Background:
- Routine screening for rubella antibodies is standard practice for pregnant women in Japan to identify subclinical infections.
- Rubella infection during pregnancy poses risks to the fetus, necessitating accurate diagnostic methods.
Purpose of the Study:
- To evaluate the diagnostic accuracy of combined rubella hemagglutination inhibition (HI) titers and rubella-specific IgM antibody index (IgM) for detecting subclinical rubella in pregnant women in Japan.
- To assess the clinical implications of positive IgM results in asymptomatic pregnant individuals.
Main Methods:
- A single-center retrospective study involving 14,965 pregnant women.
- Measurement of rubella HI titers and rubella-specific IgM values using enzyme immunoassay (IgM >1.2 considered positive).
- Correlation analysis between HI and IgM titers.
Main Results:
- 186 (1.2%) pregnant women tested IgM-positive.
- Only one clinically diagnosed rubella case with high HI and IgM titers; she terminated her pregnancy.
- A significant proportion (73.1%) of IgM-positive women had low HI titers (<1:256).
- A weak positive correlation (r=0.2527, P < 0.0001) was observed between HI and IgM titers.
Conclusions:
- A single assessment combining rubella HI and IgM antibody measurements is inadequate for diagnosing subclinical rubella in pregnant women.
- Educating pregnant women that asymptomatic IgM-positive results often do not indicate acute infection can alleviate anxiety and prevent unnecessary pregnancy terminations.
