Monitoring viral infections in pregnancy by birth certificate attendance. The experience of province of Trento – Italy
Introduction. Pregnant women can be subject to various types of infection that can have an impact on both the pregnancy and foetal health. In order to identify these conditions and institute the necessary treatments in a timely manner, guidelines recommend administering a series of serological screening tests, the timing and procedures of which are widely accepted by the whole scientific community. This paper reports on the coverage of serological screening during pregnancy and the seroprevalence of a series of viral infections amongst pregnant women receiving healthcare in the province of Trento (north-eastern Italy) between 2015 and 2019.
Materials and Methods. The data on serological screening during pregnancy are recorded on the birth attendance certificate (CEDAP) by the midwives present at birth, using an electronic template, at all maternity facilities in the province of Trento. The Authors retrospectively analysed the annual birth attendance certificate databases for all pregnant women who received care in hospital maternity facilities between 01.01.2015 and 31.12.2019. For cases in which a positive result, results pending or seroconversion were recorded, the hospital information system (Sistema Informativo Ospedaliero, SIO) was consulted to acquire information on the result of the test, the whole series of serological tests and any treatments prescribed. Serological screening coverage and seroprevalence were calculated for Rubella Virus, Cytomegalovirus (CMV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV).
Results. A total of 20,660 pregnant women were analysed. Average cover for all of the serological tests during the period considered was 97.5%, and no differences were observed with regard to the age group, academic qualifications and nationality of the pregnant women, or with regard to the maternity facility. The average seroprevalence of CMV virus was 69.5/100 pregnant women tested, with a significant downward trend during the five-year period analysed; for HBV it was 0.76/100, for HCV it was 0.39/100, for HIV it was 0.15/100 and for Rubella virus it was 90.5/100. The seroprevalence values followed an upward trend with a decrease in the pregnant woman’s academic qualifications and were higher among foreign nationals. The seroprevalence of HBV infection was higher amongst mothers originating from Eastern European countries, for HCV and CMV amongst women from Asian countries and for HIV amongst those of African origin.
Discussion. The coverage observed for serological screening shows extensive compliance with the indications provided by Italian guidelines for the monitoring of pregnancy and homogeneous management of antenatal care throughout the province. The seroprevalence values obtained are largely consistent with those of previous Italian studies. Foreign women, younger women and women with a low level of schooling warrant special attention, also with a view to possible interventions to promote healthy lifestyles and access to vaccination schemes.