The authors would like to extend their sincere thanks to all participants in the research. Especially the staff of Al-Batool Maternity and Children’s Teaching Hospital for facilitating the collection of samples and providing the laboratories.
The authors declare that they have no conflicts of interest.
Ethical approval
The research was approved by the College of Medicine Ethics Committee at the University of Babylon. The collection of samples received approval from the Research and Development Department of the Diyala and Babylon Health Directorates, in accordance with the Ministry of Health letter No. 8199, dated February 12, 2024. This study complies with the Declaration of Helsinki (2024).
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The datasets that support the findings of this study are available from the corresponding author upon reasonable request.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Alves C, Jenkins SM, Rapp A. Early Pregnancy Loss (Spontaneous Abortion).In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [PubMed]
Megli CJ, Coyne CB. Infections at the maternal–fetal interface: an overview of pathogenesis and defence.Nat Rev Microbiol. 2021;20:67–82. [DOI] [PubMed] [PMC]
Olmos-Ortiz A, Flores-Espinosa P, Mancilla-Herrera I, Vega-Sánchez R, Díaz L, Zaga-Clavellina V. Innate Immune Cells and Toll-like Receptor-Dependent Responses at the Maternal-Fetal Interface.Int J Mol Sci. 2019;20:3654. [DOI] [PubMed] [PMC]
Chan M, Smith M. Infections in Pregnancy.Compr Toxicol. 2018232–49. [DOI]
Kawai T, Ikegawa M, Ori D, Akira S. Decoding Toll-like receptors: Recent insights and perspectives in innate immunity.Immunity. 2024;57:649–73. [DOI] [PubMed]
Liu X, Wei X, Lin Y. Toll-Like Receptor-Dependent Antiviral Responses at the Maternal-Fetal Interface.Reprod Dev Med. 2020;4:249–56. [DOI]
Ikeda R, Ushio N, Abdou AM, Furuoka H, Nishikawa Y. Toll-Like Receptor 2 is Involved in Abnormal Pregnancy in Mice Infected with Toxoplasma gondii During Late Pregnancy.Front Microbiol. 2021;12:741104. [DOI] [PubMed] [PMC]
Chan HY, Moldenhauer LM, Groome HM, Schjenken JE, Robertson SA. Toll-like receptor-4 null mutation causes fetal loss and fetal growth restriction associated with impaired maternal immune tolerance in mice.Sci Rep. 2021;11:16569. [DOI] [PubMed] [PMC]
Liu G, Haw TJ, Starkey MR, Philp AM, Pavlidis S, Nalkurthi C, et al. TLR7 promotes smoke-induced experimental lung damage through the activity of mast cell tryptase.Nat Commun. 2023;14:7349. [DOI] [PubMed] [PMC]
Antontseva EV, Degtyareva AO, Korbolina EE, Damarov IS, Merkulova TI. Human-genome single nucleotide polymorphisms affecting transcription factor binding and their role in pathogenesis.Vavilov J Genet Breed. 2023;27:662–75. [DOI] [PubMed] [PMC]
Taniguchi R, Koyano S, Suzutani T, Goishi K, Ito Y, Morioka I, et al. Polymorphisms in TLR-2 are associated with congenital cytomegalovirus (CMV) infection but not with congenital CMV disease.Int J Infect Dis. 2013;17:e1092–7. [DOI] [PubMed]
Czech-Kowalska J, Jedlińska-Pijanowska D, Pleskaczyńska AK, Niezgoda A, Gradowska K, Pietrzyk A, et al. Single Nucleotide Polymorphisms of Interleukins and Toll-like Receptors and Neuroimaging Results in Newborns with Congenital HCMV Infection.Viruses. 2021;13:1783. [DOI] [PubMed] [PMC]
Frascaroli G, Rossini G, Maltoni V, Bartoletti M, Ortolani P, Gredmark-Russ S, et al. Genetic and Functional Characterization of Toll-Like Receptor Responses in Immunocompetent Patients With CMV Mononucleosis.Front Cell Infect Microbiol. 2020;10:386. [DOI] [PubMed] [PMC]
Ghailan S, Mohammed S. Assessing the risk factors for cytomegalovirus and prediction the relationship between abortion and virus in Kirkuk City Hospitals.Mosul J Nurs. 2020;8:127–41. [DOI]
Kareem QN, Hussein AA, Khalaf SK. Human cytomegalovirus and relationship with abortion among Iraqi females: a systematic review.J Ideas Health. 2022;5:739–47. [DOI]
Ali KS. The Sero-Prevalence of Cytomegalovirus Infection among Women with Abortion and Intrauterine Death in Erbil City Kurdistan Region, Iraq.Univ Diyala - Coll Med. 2020;18:77–90. [DOI]
Hashim HO, Al-Shuhaib MBS. A Novel DNA Extraction Protocol from Frozen Blood of Normal Individuals and Patients Who Received Systemic Chemotherapy preprints202009.0683.v1 [Preprint]. 2020 [cited 2024 Jul 5]. Available from: https://www.preprints.org/manuscript/202009.0683
Podilyakina Y, Stabayeva L, Kulov D, Kamyshanskiy Y, Amirbekova Z, Stundžienė R, et al. Risk factors for first-trimester spontaneous abortion and the role of preconception care.Front Glob Women’s Health. 2025;6:1615983. [DOI] [PubMed]
Kitamura A, Toriyabe K, Hagimoto-Akasaka M, Hamasaki-Shimada K, Ikejiri M, Minematsu T, et al. Revision of Cytomegalovirus Immunoglobulin M Antibody Titer Cutoff in a Maternal Antibody Screening Program in Japan: A Cohort Comparison Involving a Total of 32,000 Pregnant Women.Viruses. 2023;15:962. [DOI] [PubMed] [PMC]
Pontes KFM, Nardozza LMM, Peixoto AB, Werner H, Tonni G, Granese R, et al. Cytomegalovirus and Pregnancy: A Narrative Review.J Clin Med. 2024;13:640. [DOI] [PubMed] [PMC]
Mohammad NJ, Al-Hmudi HA, Al. Salait SK. Cytomegalovirus (CMV) IgG avidity and their relationship with immunoglobulins (IgG and IgM) levels for primary cytomegalovirus diagnosis.Int J Health Sci. 2022;6:9154–68. [DOI]
Kuliczkowska-Płaksej J, Jończyk M, Jawiarczyk-Przybyłowska A, Stachowska B, Zembska A, Grzegrzółka J, et al. The frequency of TLR2 (rs3804099, rs3804100, and rs5743708) and TLR4 (rs4986790 and rs4986791) polymorphisms in women with polycystic ovary syndrome—preliminary study.Gynecol Endocrinol. 2021;37:1027–34. [DOI] [PubMed]
Semlali A, Almutairi M, Parine NR, Al Amri A, Shaik JP, Al Naeem A, et al. No genetic relationship between TLR2 rs4696480, rs3804100, and rs3804099 gene polymorphisms and female breast cancer in Saudi populations.OncoTargets Ther. 2017;10:2325–33. [DOI] [PubMed] [PMC]
Ying LJ, Feng Y, Wang F, Feng L, Ni T. Expression of Tlrs in decidual tissue of patients with unexplained recurrent spontaneous abortion.Biomed Res. 2017;28:8577–80.
Jiao Y, Zhao J, Hu B, La X, Gong X, Huang Y, et al. Toll-like receptor 4 gene is associated with recurrent spontaneous miscarriage in Uygur and Han women in Xinjiang.Exp Ther Med. 2016;12:3268–74. [DOI] [PubMed] [PMC]
Firmal P, Shah VK, Chattopadhyay S. Insight Into TLR4-Mediated Immunomodulation in Normal Pregnancy and Related Disorders.Front Immunol. 2020;11:807. [DOI] [PubMed] [PMC]
Sánchez-Luquez K, Schadock IC, Gonçalves CV, Tornatore M, Finger-Jardim F, Avila EC, et al. Impact of TLR7 and TLR9 polymorphisms on susceptibility to placental infections and pregnancy complications.J Reprod Immunol. 2021;146:103342. [DOI] [PubMed]
Wujcicka W, Paradowska E, Studzińska M, Wilczyński J, Nowakowska D. Toll-like receptors genes polymorphisms and the occurrence of HCMV infection among pregnant women.Virol J. 2017;14:64. [DOI] [PubMed] [PMC]
Mhandire DZ, Mhandire K, Magadze M, Wonkam A, Kengne AP, Dandara C. Genetic variation in toll like receptors 2, 7, 9 and interleukin-6 is associated with cytomegalovirus infection in late pregnancy.BMC Med Genet. 2020;21:113. [DOI] [PubMed] [PMC]
Noor M, Aiken CE, Poole E, McGovern N. Human cytomegalovirus at the maternal–fetal interface: an overview of pathogenesis, defence, and interventions.Clin Sci. 2026;140:1497–520. [DOI]
Hughes BL, Clifton RG, Rouse DJ, Saade GR, Dinsmoor MJ, Reddy UM, Pass R, Allard D, Mallett G, Fette LM, Gyamfi-Bannerman C. A Trial of Hyperimmune Globulin to Prevent Congenital Cytomegalovirus Infection.N Engl J Med. 2021;385:436–44. [DOI]
Al-Mousawi HT, Al-Hajjar QN. Immunological and Molecular Diagnosis of Cytomegalovirus Infection between Aborted & Pregnant Women in Babylon City.Baghdad Sci J. 2021;18:28. [DOI]
