Seroprevalence and Molecular Detection of Cytomegalovirus UL146 and US28 Gene Expression in Women With Recurrent Pregnancy Loss

Background Human cytomegalovirus (CMV) is a global herpesvirus that is highly prevalent worldwide and is able to establish lifelong latency after initial infection. The infection is highly frequent during pregnancy in human beings, which leads to preterm birth in some cases. Circulating strains of CMV carry a high number of variable or disrupted genes. Some of these like UL146, a highly diverse gene, and the US28 gene are involved in viral dissemination. This study aims to determine the seroprevalence of CMV and to investigate whether the highly variable UL146 and US28 genes, isolated from the blood of seropositive women, are associated with recurrent pregnancy loss. Material and methods This cross-sectional study was carried out in Erbil City, Iraq from October 2022 to July 2023. A total of 150 women at their reproductive age with a history of miscarriage who attended Maternity Teaching Hospital were enrolled. Anti-CMV IgG and IgM antibodies were assessed by enzyme-linked immunosorbent assay (ELISA). Highly variable UL146 and US28 genes of CMV from seropositive samples were amplified by conventional polymerase chain reaction (PCR), and the results were visualized on a UV-transilluminator. SPSS version 22 (IBM Corp., Armonk, NY, USA) was used for data entry and analysis. The p-value less than 0.05 was regarded as statistically significant. Results Anti-CMV IgG and IgM were seropositive in 103 (53.3%) and 13 (8.7%) women, respectively, and only 10 (6.7%) of them for both anti-CMV IgG and IgM. Significant associations of CMV and history of miscarriage, age, educational level, and gestational age of miscarriages were observed (p-value less than 0.05). On the other hand, no statistically significant association between CMV and socioeconomic level or residency was observed. The frequencies of genetic analysis of UL146 and US28 of the 103 seropositive tested samples of women with a history of miscarriage were 31 (30.1%) and nine (8.7%), respectively. A significant association between recurrent miscarriage and UL146 gene expression was observed. PCR targeting the UL146 demonstrated greater sensitivity for diagnosing CMV. Conclusion The seroprevalence of CMV is relatively high in Erbil, and the UL146 and US28 genes can act as factors in the initial level of CMV. Therefore, molecular detection of these genes can aid in determining the virulence of CMV strains.