DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20195832

Cost-effectiveness analysis of serological prenatal screening for pregnant women in King Abdulaziz University Hospital: a single-center retrospective study

Atheer Yahya Saeed Asiri, Ibtisam Talak Audallah Alsawa, Anas Mahmoud Omar Fallatah, Sondos Sami Hussein, Hisham Z. Alshehri, Aseel Ahmed Mohammedali Aljahdali, Arwa Zuhair Fatani, Samera Albasri

Abstract


Background: Congenital primary infections with Toxoplasma gondii, cytomegalovirus (CMV), Epstein–Bar virus (EBV), rubella, and hepatitis B virus (HBV) are viral infections transmitted transplacentally through the blood to the fetus and can be life-threatening. Therefore, we aimed to determine the prevalence of these infections and assess the cost-effectiveness of blood tests among pregnant women with positive serologies.

Methods: This retrospective review was conducted among pregnant women with positive prenatal screening serology test results between January 2013 to July 2018. A p-value of <0.05 was used to calculate statistical significance.

Results: Overall, 9095 pregnant women delivered in the last 5 years. Of these, 97 had positive prenatal screening serology and were enrolled in our study. Of 97, 61 (62.9%) were Saudis and 36 (37.1%) non-Saudis. The prevalence rates of rubella, CMV, EBV, and HBV were 78.35%, 59.79%, 14.43%, and 5.15%, respectively. Additionally, 44 of 97 women developed undesired antepartum outcomes, whereas 47 had adverse neonatal outcomes. CMV, HBV, and rubella were significantly associated with adverse pregnancy outcomes (P<0.005). During the study period, USD 1460228.27 was spent to screen 9095 pregnant women and USD 15573.68 to diagnose 97 pregnant women with positive serology.

Conclusions: Because infections with toxoplasma, CMV, EBV, rubella, and HBV can cause serious risk to the mother and fetus during pregnancy. Thus, setting new hospital policies regarding early screening for high-risk pregnancies and early detection of these infections during prenatal visits are inevitable to avoid undesired outcomes.


Keywords


Prenatal screening, Congenital primary infections, Fetal health

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References


Maruyama Y, Sameshima H, Kamitomo M, Ibara S, Kaneko M, Ikenoue T, et al. Fetal manifestations and poor outcomes of congenital cytomegalovirus infections: Possible candidates for intrauterine antiviral treatments. J Obstet Gynaecol Res. 2007;33(5):619-23.

Stegmann BJ, Carey JC: TORCH infections. Toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus (CMV), and herpes infections. Curr Womens Health Rep. 2002;2(4):253-8.

Kumar V, Abbas AK, Fausto N, Aster JC. Robbins & Cotran: Pathologic basis of disease (8th edition). Philadelphia, PA: Elsevier; 2009: 480.

Maldonado YA, Nizet V, Klein JO, Remington JS, Wilson CB. Current concepts of infections of the fetus and newborn infant. In: Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA (Eds). Infectious diseases of the fetus and newborn infant. 7th edition. Philadelphia: Elsevier Saunders; 2011: 2-23.

Vogel N, Kirisits M, Michael E, Bach H, Hostetter M, Boyer K, et al. Congenital toxoplasmosis transmitted from an immunologically competent mother infected before conception. Clin Infect Dis. 1996;23(5):1055-60.

Cook AJ, Holliman R, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, et al. Sources of toxoplasma infection in pregnant women: European multicentre case-control study Commentary: Congenital toxoplasmosis—further thought for food. BMJ. 2000;321(7254):142-7..

Messier V, Levesque B, Proulx JF, Rochette L, Libman MD, Ward BJ, et al. Seroprevalence of toxoplasma gondii among nunavik inuit (Canada). Zoonoses Public Health. 2009;56(4):188-97.

Cook AJ, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, et al. Sources of toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis. BMJ. 2000;321(7254):142-7.

Carlson A, Norwitz ER, Stiller RJ. Cytomegalovirus infection in pregnancy: Should all women be screened? Rev Obstet Gynecol. 2010;3(4):172-9.

Stagno S, Pass RF, Cloud G, Britt WJ, Henderson RE, Walton PD, et al. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA. 1986;256(14):1904-8.

Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA. Symptomatic congenital cytomegalovirus infection: Neonatal morbidity and mortality. Pediatr Infect Dis J. 1992;11(2):93-9.

De Paschale M, Agrappi C, Manco MT, Paganini A, Clerici P. Incidence and risk of cytomegalovirus infection during pregnancy in an urban area of Northern Italy. Infect Dis Obstet Gynecol. 2009;2009(20):206505.

Mujtaba G, Shaukat S, Angez M, Alam MM, Hasan F, Zahoor Zaidi SS, et al. Seroprevalence of human cytomegalovirus (HCMV) infection in pregnant women and outcomes of pregnancies with active infection. J Pak Med Assoc. 2016;66(8):1009-14.

Uyar Y, Balci A, Akcali A, Cabar C. Prevalence of rubella and cytomegalovirus antibodies among pregnant women in northern Turkey. New Microbiol 2008;31(4):451-5.

Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol 2015;42(1):77-103.

Ghazi HO, Telmesani AM, Mahomed MF. TORCH agents in pregnant Saudi women. Med Princ Pract. 2002;11(4):180-2.

Agbede OO, Adeyemi OO, Olatinwo AWO, Salisu TJ, Kolawole OM. Sero-Prevalence of antenatal rubella in UITH. Open Publ Health J. 2011;4:10-6.

Sadik MS, Fatima H, Jamil K, Patil C. Study of TORCH profile in patients with bad obstetric history. Biol Med 2012;4(2):95-101.

Kumari N, Morris N, Dutta R. Is screening of TORCH worthwhile in women with bad obstetric history: An observation from eastern Nepal. J Health Popul Nutr. 2011;29(1):77-80.

Inagaki ADM, Oliveira LAR, Oliveira MFB, Santos RCS, Araujo RM, Alves JAB, et al. Seroprevalence of antibodies for toxoplasmosis, rubella, cytomegalovirus, syphilis and HIV among women in Sergipe. Rev Soc Bras Med Trop 2009;42(5):532-6.

Hamdan HZ, Abdelbagi I, Nasser NM, Adam I. Seroprevalence of cytomegalovirus and rubella among pregnant women in western Sudan. Virol J. 2011;8(1):217.

Caidi H, Bloom S, Azilmaat M, Benjouad A, Reef S, El Aouad R. Rubella seroprevalence among women aged 15-39 years in Morocco. East Mediterr Health J. 2009;15(3):526-31.

Ocama P, Opio CK, Lee WM. Hepatitis B virus infection: Current status. Am J Med. 2005;118(12):1413.

Oshitani H, Kasoslo C, Tembo M, Mpabalwani M, Mizuta K, Luo N, et al. Hepatitis B virus infection among pregnant women in Zambia. East Afr Med J. 1995;72(12):813-5.

Kwan L. C, Ho YY, Lee SS. The declining HBsAg carriage rate in pregnant women in Hong Kong. Epidemiol Infect 1997;119(2):281-3.

Euler GL, Worten KG, Baughman AL, Williams WW. Hepatitis B surface antigen prevalence among pregnant women in urban areas: Implications for testing, reporting, preventing perinatal transmission. Pediatrics. 2003;111(5 Pt 2):1192-7.

El Mouzan MI, Al Mofleh IA. The Saudi Journal of Gastroenterology. Saudi J Gastroenterol. 1995;1(2):73-4.

Beasley RP, Hwang LY, Stevens CE, Lin CC, Hsieh FJ, Wang KY, et al. Efficacy of hepatitis B immune globulin for prevention of perinatal transmission of the hepatitis B virus carier state: Final report of a randomized double-blind, placebo-controlled trial. Hepatology. 1983;3(2):135-41.

Keller MA, Stiehm ER. Passive immunity in prevention and treatment of infectious diseases. Clin Microbiol Rev. 2000;13(4):602-14.

CDC. Protection against viral hepatitis: Recommendations of the immunization practices advisory committee (ACIP). MMWR Recomm Rep. 1990;39(RR-2):1-26.

Uysal, Ahmet, Taner CE, Cüce M, Atalay S, Göl B, Köse S, et al. Cytomegalovirus and Rubella Seroprevalence in Pregnant Women in Izmir/Turkey: Follow-up and Results of Pregnancy Outcome. Arch Gynecol Obstet. 2012;286(3):605-8.

Muliyil DE, Singh P, Jois SK, Otiv S, Suri V, Varma V, et al. Sero-prevalence of rubella among pregnant women in India. 2018;36(52):7909-12.

El Sanousi SM, Osman ZA, Mohmed AB, Al Awfi MS. Cytomegalovirus infection in a cohort of pregnant women. Am J Infect Control. 2016;44(4):41-3.

Maingi Z, Nyamache AK. Seroprevalence of Cytomegalo Virus (CMV) among pregnant women in Thika, Kenya. BMC Res Notes. 2014;7(1):794.

Shigemi D, Yamaguchi S, Otsuka T, Kamoi S, Takeshita T. Seroprevalence of cytomegalovirus IgG antibodies among pregnant women in Japan from 2009-2014. Am J Infect Control. 2015;43(11):1218-21.

Pembrey L, Raynor P, Griffiths P, Chaytor S, Wright J, Hall AJ. Seroprevalence of cytomegalovirus, epstein barr virus and varicella zoster virus among pregnant women in Bradford: A cohort study. PLoS One. 2013;8(11):e81881.

Awole M, Gebre-Selassie S. Seroprevalence of HBsAg and its risk factors amoung pregnant women in Jimma, Southwest Ethiopia. Ethiop J Health Dev. 2005;19(1):45-50.

Barros MMO, Ronchini KROM, Soares RLS. Hepatitis b and c in pregnant women attended by a prenatal program in an universitary hospital in Rio De Janeiro, Brazil: Retrospective study of seroprevalence screening. Arq Gastroenterol. 2018;55(3):267-73.

Dalaba MA, Akweongo P, Aborigo RA, Saronga HP, Williams J, Blank A, et al. Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana. PLoS One. 2015;10(5):e0125920.

Neke N, Reifferscheid A, Buchberger B, Wasem J. Time and cost associated with utilization of services at mobile health clinics among pregnant women. BMC Health Serv Res. 2018;18(1):920.