In Utero Infection with Coxsackievirus-B is Associated with Congenital Pulmonary Atresia

The research for this study was undertaken to examine association between perinatal infection with Coxsackievirus B (CVB) and congenital heart defects (CHD). Suggestive, although inconclusive, data exists of an association between CVB infection during pregnancy and CHD. We present data from a clinical study showing that CVB infection in early pregnancy induces heart defects. In a prospective study of 123 pregnant women with pregnancies affected with CHD we found circulating CVB IgG and IgM in the serum. A significant number of the women were positive for CVB antibodies; 30.9% for IgG and 6.5% for IgM. Our data demonstrates not only an association of CVB with CHD in pregnant women but this is the first report showing significant association between in-utero CVB infection and Pulmonary Atresia (PA) and HLHS (AA/MS variant). Elevated levels of IgG were seen in 55.5% of women carrying babies with PA and 60% of women carrying babies with HLHS (AA/MS), with p-values of 0.01 and 0.03 respectively. To determine specific CVB serotypes involved, neutralizing antibody titers to CVB1, CVB3, and CVB4 were analyzed on samples with positive IgG/IgM levels, and showed a possible association between CVB4 and CHD in the cohort. Our study has broad implications for the future understanding and potential management of CHD as well as introduces a new avenue of research for cardiac defects.