Pregnant women in Yemen face many challenges, including medical challenges represented by the lack of appropriate health care during pregnancy and childbirth and the lack of awareness programs that increase women’s awareness of the necessary precautions during the stages of pregnancy. Many studies have focused on the spread of viral and bacterial diseases in pregnant women in Yemen [23–25]. According to our knowledge, this study is the first report that evaluated the effect of HCMV on some hematological parameters and liver function in pregnant women in the governorate of Hajjah, Yemen.
The present outcomes revealed that the majority of infected pregnant women were in the age group of 16–21 years (34.7%). In a similar study, the high rate of HCMV infection was among pregnant women in the age group of 15–25 years [10] and 14–30 years [13]. This study is inconsistent because it documented that the high rate of HCMV infection was among pregnant women in the age group of 25–34 years (97.3%) [14] and 31–40 years [12]. In general, the frequency of HCMV is higher among women, people in older age brackets, people with lower socioeconomic status, and people in developing countries. The global prevalence of HCMV in women of reproductive age varies from 45–100% [26].
The difference in the results may be attributed to a variety of factors, such as geographical location, survey duration, study subject characteristics, differences in inclusion criteria, diagnostic approach, sample size, application of preventative and control measures, and socioeconomic status. However, other factors, such as hygienic practices, awareness, and the studied community, could also contribute to these discrepancies.
According to the current results, those who studied in secondary schools (46.2%) had the highest rate of HCMV prevalence. Different studies found a high proportion of HCMV infections in pregnant women with basic levels of education [10, 14]. In terms of gestational stage, pregnant women experienced the highest rate of HCMV infection in their second trimester (65.4%). Previously, HCMV had a high seroprevalence rate among pregnant women in the third and first trimesters [13], the first trimester [10], and the third trimester (95.9%) [14].
Pregnancy does not seem to increase the severity of maternal HCMV disease; however, among pregnant women, cervical shedding may be more common as pregnancy progresses. The incidence of occurrence is 5% during the first trimester, 6–10% during the second trimester, and 11–28% during the third trimester [27]. In this study, pregnant women with multigravida had a higher rate of HCMV infection (69.2%) compared with primigravida (30.8%). In earlier reports, it was documented that a high rate of HCMV was found in women with a parity of more than one child [10, 13 − 14].
This finding showed that approximately 50% of infected pregnant women had a history of abortion, and this result is in agreement with other research studies [13]. Gubran [28] conducted a study in Aden City, Yemen, and found that 83.3% of aborted women tested positive for HCMV-IgM antibodies. Therefore, additional investigations are necessary to identify HCMV and other factors that cause abortion in different regions of Yemen.
Furthermore, approximately 23.1% of pregnant women infected with HCMV have a history of congenital disease. This study is consistent with a previous report [10]. The prevalence of congenital HCMV is approximately 0.2-2.0% among all pregnancies. Each year in the United States, an estimated 20,000 to 40,000 newborns are born with congenital HCMV infection, as reported by Hughes et al. [29]. Screening for HCMV during pregnancy is not regarded as the most effective approach for preventing congenital infection. The lack of an effective antiviral treatment significantly contributes to the transmission of the virus from mother to fetus, resulting in either abortion or congenital abnormalities. Therefore, it is required to periodically screen women of childbearing age for HCMV infection in order to reduce the adverse outcomes of pregnancy caused by HCMV infection.
HCMV has a consistent impact on regulating the balance of blood T cells and a more extensive influence on other populations of lymphoid and myeloid cells [30]. This result showed that the mean WBC counts were significantly lower in patients with HCMV than in HC (P < 0.05). In contrast, the mean PLT concentration was higher in the HCMV group than in the HC group (P < 0.05). In contrast, there was no statistically significant difference between HCMV patients and HC in the mean concentrations of HB and RBC (P > 0.05).
In a study by Saleh et al. [31], the concentration of Hb and neutrophil count in patients with HCMV were 13.0233 and 75.2300, respectively, compared to the control group's values of 12.8733 and 74.2800, respectively, (P > 0.05). In addition, Hama and Abdurahman [32] observed similar results, indicating that HCMV seropositivity does not have a substantial impact on some blood parameters such as Hb concentration. However, Alebady et al. [33] showed a significant drop in haemoglobin (Hb) and neutrophil count in HCMV patients. HCMV is an intracellular virus found inside leukocytes that is particularly abundant in the neutrophil component of the buffy coat [34]. Laboratory tests showed normal results for the metabolic panel, renal function, and total blood count, except for a slight increase in the white blood cell count [35].
People with thalassemia (95.1%) and blood cancers (75.5%) were more likely to have a HCMV infection, according to a study of people with these conditions [36–37]. In Bahia, Brazil, individuals with various haematological illnesses had a high frequency of HCMV infection (89.4%) [38]. Prior studies have established a correlation between microbial infection and the occurrence of haematological diseases [39–42].
Another report recorded that the median white cell count in the HCMV-positive group was considerably greater than that in the HCMV-negative group (10.1×109 cells/L versus 6.0×109 cells/L, P = 0.001). In addition, there were no notable differences in other laboratory tests, such as transaminases, coagulation function, hemoglobin, platelets, erythrocyte sedimentation rate (ESR), C-reactive protein, procalcitonin, ferritin, and lactic acid levels between patients who experienced HCMV reactivation and those who did not [43].
Despite congenital HCMV infection carries significant consequences and is highly prevalent in terms of absolute numbers, pregnant women typically possess limited awareness of this condition, and healthcare professionals responsible for their care do not typically provide guidance on primary prevention. Pregnant women and those planning to conceive should be educated about this illness and methods to enhance cleanliness in order to prevent transmission [44–45].
This study revealed a significant decrease in the mean levels of total bilirubin and direct bilirubin in patients with HCMV compared to those in healthy controls (P < 0.05). According to Vig et al. [46], the study HCMV-positive group had substantially higher mean total and direct bilirubin readings than the HCMV-negative group (P < 0.05). HCMV infection during pregnancy markedly elevated bile duct damage-associated markers, including total bile acid, direct bilirubin, and γ-glutamyl transpeptidase (γ-GT) [47]. Therefore, prognosis prediction and risk classification depend on the identification of HCMV positive. To determine if adjuvant antiviral medication can reverse this damage and enhance the prognosis for patients with HCMV-positive biliary atresia overall, more research is necessary.
In the current study, the mean SGOT and ALP levels were lower among HCMV patients than among HC (P < 0.05). This finding disagrees with the report by Zahid et al. [35], who showed an increase in ALP levels to 254 u/L. Recent measurements of mean ALP levels in the study and control groups revealed a significant difference [46]. In addition, Farag et al. [17] demonstrated an association between HCMV positivity and ALT, AST, ALP, and GGT levels. There was a significant difference in the positive correlations between the two antibodies. Furthermore, the four determined liver enzymes and two antibodies had independent correlations that allowed for the determination of simultaneous liver damage linked to HCMV infection.
Furthermore, primary biliary cirrhosis and autoimmune hepatitis are frequently inducing by HCMV infection. This explains the highly significant positive association between HCMV antibodies and AST, ALT, and ALP that shown in the three age groups that were tested [48–49].
The present results showed that the albumin level was significantly lower in specimens collected from patients with HCMV than in those collected from HC (P < 0.05). The serum albumin level in the HCMV-positive group was significantly lower than that in the HCMV-negative group (P = 0.039) [43]. In contrast, there was no statistically significant difference between HCMV patients and HC in the mean concentrations of SGPT and total protein (P > 0.05). This finding is inconsistent with the results of a study by Zahid et al. [35].