Immunoglobulins in umbilical cord plasma. II. Congenital deformities, other abnormalities, and multiple pregnancies.

The association between maternal rubella infection in the first trimester ofpregnancy and congenital malformations of the infant is well recognized. In the case of other virus infections of early pregnancy, the relation is less certain, and though suspicion has been attached to certain viruses, particularly mumps (Ylinen and Jarvinen, 1953) and influenza (Coffey and Jessop, 1959, 1963), some series of influenza cases have shown no such relation (Walker and McKee, 1959; Wilson, Heins, Imagawa, and Adams, 1959). Other infections of the foetus may also cause structural abnormalities of the foetus, e.g. toxoplasmosis infection may be associated with hydrocephalus and microphthalmia. Maternal variola during pregnancy can cause abortion, stillbirth, or neonatal death (Plotz, 1965), and even the infants of healthy immune mothers may be infected in utero and may die from congenital variola (Schick, 1949; Rao, Ratnakannan, Balasubramaniam, and Gopalan, 1954). A similar situation exists with rubella (Schick, 1949). A high incidence of premature births has been recorded with maternal viral hepatitis (Zondek and Bromberg, 1947), though only a small percentage of infants born of mothers with this infection show overt disease (Plotz, 1965). In the case of Coxsackie virus, clinical manifestations in the mother may be slight, yet the infant may be fatally affected (Benirschke and Pendleton, 1958; Sussman, Strauss, and Hodes, 1959). These facts suggest that maternal and perhaps foetal infection may be an unrecognized cause of a number of congenital malformations, abortions, stillbirths, premature births, and neonatal deaths. The foetus infected by syphilis or toxoplasmosis will produce antibodies in utero (Silverstein, 1962; Eichenwald and Shinefield, 1963). Similarly, in cases of antenatal infection by rubella virus and cytomegalic inclusion virus, there is evidence that the foetus is producing antibodies, and raised