A novel risk classification system for preconception health and sero-epidemiological map of Toxoplasma, Rubella and Cytomegalovirus infections among couples planning a pregnancy in rural China: A nationwide study

Abstract

<i>Objectives</i> - The aim of this thesis was to evaluate the feasibility, effectiveness and impact of preconception health screening strategy and a novel risk classification system of China`s “National Preconception Health Care Project (NPHCP)” in identifying risk factors and stratifying couples’ preconception care (PCC), and to establish a sero-epidemiological map of TORC infections in the preconception period.<p>

<p><i>Methods</i> - This study utilized data from NPHCP, a population-based, cross-sectional, nation-wide study that was conducted during 2010–12 in 220 rural counties located in 31 provinces and province level municipalities of mainland China. Risk factors were categorized into five preconception risk classes based on their amenability to prevention and treatment. Results of TORC serology and collected socio-demographic and clinical data of the participating couples were extracted and further analyzed to estimate sero-prevalence in the sample population, explore regional differences, and identify associated risk factors. <p>

<p><i>Results</i> - Among the 2142849 couples enrolled to this study, 1463266 (68.29%) couples had one or more preconception risk factors, mainly of category A, B or C, among which 46.25% were women and 51.92% were men. 45405 (2.3%) women were IgG positive and 6884 (0.3%) were IgM positive. Advanced maternal age, occupation of a farmer, vegetarian diet and exposure to cats were significantly associated with Toxoplasma gondii IgG and IgM sero-positivity. The overall prevalence of Rubella virus IgG sero-positivity was 58.4% (n=1161129). Only 4.6% (n=91604) women reported to have had Rubella virus vaccination, and self-reported vaccination status did not correlate with Rubella virus IgG sero-positivity. 42.1% (n=850592) women were CMV IgG positive with 0.4% (n=9290) IgM positive. CMV IgG negative women were of younger age, whereas the elder women were more likely to be CMV IgM positive (P<0.0001). <p>

<p><i>Conclusions</i> - Preconception health screening and use of a novel risk classification system could effectively identify important risk factors and stratify couples into five different risk categories. Involvement of male partners in PCC is of equal importance. Targeted screening of TORC infections followed by referral, diagnosis, treatment, counseling, health education and vaccination before pregnancy should be considered for reducing the risk of vertical transmission during pregnancy and childbirth.