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Perinatal Complications Are Associated with
Seropositivity for Chlamydia trachomatis During
Pregnancy
SIR-Chlamydial infections during pregnancy may cause a variety
of perinatal complications. Recently Gencay et al. [1] reported
that the rates of seropositivity for IgM antibodies to Chlamydia
trachomatis during pregnancy were significantly higher among
mothers who had given birth to infants with complications than
among matched controls. Inclusion conjunctivitis, pneumonia, and
other complications may develop in neonates born to mothers infected with C. trachomatis. Chlamydial infections in infants are
usually caused by transvaginal transmission of C. trachomatis from
mother to infant. Delivery of low-birth-weight infants and premature rupture of membranes occurred more frequently among
women infected with C. trachomatis. It has been suggested that
C. trachomatis infection in pregnant women may result in premature labor and perinatal death.
From January 1993 to December 1994, serum samples were
collected from 178 pregnant women at 10 and 22 weeks of gestation. A commercially available EIA kit (SERa IPELISA CHLAMYDIA, Meiji Milk Products, Tokyo) was also used to detect
serum IgG, IgA, and IgM antibodies to C. trachomatis. Testing
and interpretation of the results were performed according to the
manufacturer's instructions.
Of the 178 pregnant women, 10 (5.6%) had IgG and IgM antibodies to C. trachomatis detected with use of ELISA. Twenty-one
(11.8%) of the 178 women had IgG and IgA antibodies to
C. trachomatis. None of the 10 women with IgG and IgM antibod-
Reprints or correspondence: Dr. Kei Numazaki, Department of Pediatrics,
School of Medicine, Sapporo Medical University, S.1 W.16 Chuo-ku, Sapporo,
060 Japan.
Clinical Infectious Diseases 1996;23:208
© 1996 by The Universityof Chicago. All rights reserved.
1058--4838/96/2301-0047$02.00
Reply
SIR-We appreciate the interest and the comments of Numazaki et al. with regard to our recent article [1]. We find their
results important in terms of the diagnosis of Chlamydia trachomatis infections. We have not had experience with the EIA
Reprints or correspondence: Mesut Gencay, MSc., Department of Virology,
Haartman Institute, P.D.B. 21, FIN-OOOI4 Helsinki University, Finland.
Clinical Infectious Diseases 1996;23:208-9
© 1996 by The Universityof Chicago.All rights reserved.
1058--4838/96/2301-0048$02.00
ern 1996;23 (July)
Correspondence
ies to the organism had complications during pregnancy, and the
10 babies born to these women had no perinatal complications.
Five babies born to five of the 21 women with IgG and IgA
antibodies to C. trachomatis had fetal and neonatal distress. The
membranes of one of these 21 women ruptured prematurely, but
the baby had no perinatal complications.
Several investigators have reported that 2%-20% of pregnant
women harbor C. trachomatis in the endocervix [2]. Pregnant
women who carry C. trachomatis in their genital tracts may have
a general disturbance of immunoregulation. Although transmission
of the organism from mothers to their infants generally occurs with
passage of the infant through the infected cervix, the possibility
of intrauterine infection has been reported. Chorioamnionitis is a
frequent finding in premature infants, and respiratory insufficiency
in such infants may be attributable to intrauterine infection.
The fact that neonates who have the symptoms of chronic lung
disease also have elevated levels of serum IgM suggests that these
respiratory tract disorders arise from infections during pregnancy
[1, 3]. Early diagnosis and appropriate treatment of chlamydial
infections may reduce these complications. Detection of serum
IgG and IgA antibodies to C. trachomatis during pregnancy also
permits more laboratories to diagnose perinatal chlamydial infections and may be useful in screening for the infection.
Kei Numazaki, Takuo Kusaka, and Shunzo Chiba
Department of Pediatrics, Sapporo Medical University School of
Medicine; and Department of Pediatrics, NTT Sapporo Hospital,
Sapporo, Japan
References
1. Gencay M, Koskiniemi M, Saikku P, et al. Chlamydia trachomatis seropositivity during pregnancy is associated with perinatal complications. Clin
Infect Dis 1995;21:424-6.
2. Numazaki K, Wainberg MA, McDonald 1. Chlamydia trachomatis infections in infants. Can Med Assoc J 1989; 140:615-22.
3. Numazaki K, Chiba S, Kogawa K, Umetsu M, Motoya H, Nakao T. Chronic
respiratory disease in premature infants caused by Chlamydia trachomatis. J Clin Pathol 1986; 39:84-9.
test used by those authors. Detection of C. trachomatisspecific IgA antibodies is probably important in the serological
evaluation of C. trachomatis infections. We have used the
microimmunofluorescence (micro-IF) method, which allows
detection of IgM and IgG antibodies to specific C. trachomatis
serotypes [2]; moreover, this method allows us to differentiate
between antibodies that have originated from Chlamydia pneumoniae infections or C. trachomatis infections. Our microimmunofluorescence test is based on long experience, and only
bright fluorescence of the elementary bodies (c. pneumoniae
and C. trachomatis) is accepted.
Thus far, we have only limited data on IgA determination
by means of microimmunofluorescence. In our retrospective
study, C. trachomatis was a significant finding in mothers who