Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis

Simonazzi, Giuliana; Cervi, Francesca; Zavatta, Alice; Pellizzoni, Laura; Guerra, Brunella; Mastroroberto, Marianna; Morselli-Labate, Antonio Maria; Gabrielli, Liliana; Rizzo, Nicola; Lazzarotto, Tiziana

doi:10.1093/cid/ciw700

Cited by 22 publications

(29 citation statements)

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“…The value of viral DNA detection and quantification in blood, saliva, or urine to help determine the timing of maternal infection, or to estimate the risk of fetal transmission, is not yet established. Notably, two studies have demonstrated that persisting levels of maternal DNAemia during primary CMV infection at the moment of amniocentesis correlate with a high risk of CMV transmission to the fetus (26,27), whilst one other study has shown that the presence of CMV DNA in maternal urine and maternal blood correlated with transmission of CMV to offspring (28).…”

Section: Serologic and Molecular Testing For Maternal CMV Infectionmentioning

confidence: 99%

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

et al. 2020

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Maternal primary and non-primary cytomegalovirus (CMV) infection during pregnancy can result in in utero transmission to the developing fetus. Congenital CMV (cCMV) can result in significant morbidity, mortality or long-term sequelae, including sensorineural hearing loss, the most common sequela. As a leading cause of congenital infections worldwide, cCMV infection meets many of the criteria for screening. However, currently there are no universal programs that offer maternal or neonatal screening to identify infected mothers and infants, no vaccines to prevent infection, and no efficacious and safe therapies available for the treatment of maternal or fetal CMV infection. Data has shown that there are several maternal and neonatal screening strategies, and diagnostic methodologies, that allow the identification of those at risk of developing sequelae and adequately detect cCMV. Nevertheless, many questions remain unanswered in this field. Well-designed clinical trials to address several facets of CMV treatment (in pregnant women, CMV-infected fetuses and both symptomatic and asymptomatic neonates and children) are required. Prevention (vaccines), biology and transmission factors associated with non-primary CMV, and the cost-effectiveness of universal screening, all demand further exploration to fully realize the ultimate goal of preventing cCMV. In the meantime, prevention of primary infection during pregnancy should be championed to all by means of hygiene education.

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Section: Serologic and Molecular Testing For Maternal CMV Infectionmentioning

confidence: 99%

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

et al. 2020

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Section: Questionmentioning

confidence: 97%

“…The possibility of an increased preterm birth mechanism associated with intrauterine viral infection in the late second and third trimester alone has limited data to support this perinatal risk [19,46,47]. Table 3 summarizes the published literature for maternal infection cohorts and the outcomes for unintended fetal loss and evaluations to determine the possibility of fetal VT [48][49][50][51][52][53][54][55][56]. The "pooled" procedure-related fetal loss risk estimate for infectious diagnostic amniocentesis procedures is estimated at 1.5% (18/1,187) -0.8% from varicella (1/127), 0% from HCMV (0/458), and 2.8% from toxoplasmosis (17/602).…”

Section: Questionmentioning

confidence: 99%

“…The biological VT to the fetus for CMV appears to be increased with a positive maternal viremia (OR 3.06, 95% CI 1.41-6.64) [52] and the transmission evidence with the identification of fetal "disruptive" anomalies by US [54]. A negative (undetected) maternal CMV viremia result has a reported viral VT rate of 15-20% [52,53]. In a retrospectively analyzed amniocentesis cohort with suspected toxoplasmosis infection, a spontaneous transplacental VT rate of 4.5% (15/332) was associated with a positive amniotic fluid viral PCR result (14/15 cases) [56].…”

Section: Questionmentioning

confidence: 99%

“…In a retrospectively analyzed amniocentesis cohort with suspected toxoplasmosis infection, a spontaneous transplacental VT rate of 4.5% (15/332) was associated with a positive amniotic fluid viral PCR result (14/15 cases) [56]. Amniocentesis was not associated with an increased VT risk [48,49,[52][53][54]56]. Varicella infection and VT risks has been analyzed.…”

Section: Questionmentioning

confidence: 99%

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Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Wilson

2020

Fetal Diagn Ther

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Background: The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment. Methods: This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts. Results: The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased. Conclusion: The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.

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Interface‐Stabilized Fiber Sensor for Real‐Time Monitoring of Amniotic Fluid During Pregnancy

Li,

et al. 2023

Advanced Materials

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Diseases in pregnancy endanger millions of fetuses worldwide every year. The onset of these diseases can be early warned by the dynamic abnormalities of biochemicals in amniotic fluid, thus requiring real‐time monitoring. However, when continuously penetrated by detection devices, the amnion is prone to loss of robustness and rupture, which is difficult to regenerate. Here, we present an interface‐stabilized fiber sensor for real‐time monitoring of biochemical dynamics in amniotic fluid during pregnancy. The sensor is seamlessly integrated into the amnion through tissue adhesion, amniotic regeneration and uniform stress distribution, posing no risk to the amniotic fluid environment. The sensor demonstrates a response performance of less than 0.3% fluctuation under complex dynamic conditions and an accuracy of more than 98% from the second to the third trimester. By applying it to early warning of diseases such as intrauterine hypoxia, intrauterine infection, and fetal growth restriction, fetal survival increases to 95% with timely intervention.This article is protected by copyright. All rights reserved

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Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis

Abstract: Maternal viremia at amniocentesis is associated with a 3-fold greater chance of congenital infection, but it is not correlated with symptomatic disease.

Cited by 22 publications

References 28 publications

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Interface‐Stabilized Fiber Sensor for Real‐Time Monitoring of Amniotic Fluid During Pregnancy

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