Prognostic model for the development of chronic subcompensated placental insufficiency in pregnant women with cytomegalovirus infection

Introduction. Exacerbation of cytomegalovirus (CMV) infection during pregnancy is a significant risk factor for obstetric complications; however, the complex immunological and endocrine alterations preceding placental dysfunction remain poorly understood.
Aim. To develop a prognostic model for the development of chronic subcompensated placental insufficiency (PI) in pregnant women with CMV infection based on a comprehensive assessment of immune response markers (immunoglobulin (Ig) M, circulating immune complexes (CIC), tumor necrosis factor (TNF)-α, interleukins (IL)-1β and -4), endothelial function indicators (endothelin-1, nitrite anion (NO₂⁻)), and hormonal profile (progesterone, cortisol).
Materials and methods. The study included 27 pregnant women with exacerbation of chronic CMV infection in the second trimester and subsequent remission in the third trimester, complicated by subcompensated PI. The comparison group consisted of 35 CMV-seronegative pregnant women at comparable gestational ages. Study materials included peripheral blood, urine, and buccal epithelium. CMV-specific IgM and IgG, IgG avidity index, levels of IL-1β, IL-4, TNF-α, endothelin-1, NO2⁻, progesterone, cortisol, and total IgM were measured by enzyme-linked immunosorbent assay (ELISA). CIC levels were determined by turbidimetric analysis.
Results. CMV exacerbation in the second trimester was associated with significantly elevated concentrations of IL-1β (p < 0.0001), TNF-α (p < 0.0001), IgM (p < 0.001), CIC (p < 0.001), endothelin-1 (p < 0.0001), and cortisol (p < 0.0001), along with reduced levels of IL-4 (p < 0.0001), NO2⁻ (p < 0.01), and progesterone (p < 0.0001) in peripheral blood. A prognostic model for the development of subcompensated PI in the third trimester was developed based on these parameters in women with second-trimester CMV exacerbation.
Conclusion. Assessment of IgM, CIC, TNF-α, IL-1β, IL-4, endothelin-1, NO2⁻, progesterone, and cortisol can be integrated into a comprehensive diagnostic monitoring strategy for pregnant women with CMV infection to identify those at high risk of developing subcompensated placental insufficiency.

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