Cytomegalovirus infection during pregnancy: state of the science

Leruez‐Ville, Marianne; Foulon, Ina; Pass, Robert F.; Ville, Y.

doi:10.1016/j.ajog.2020.02.018

Cited by 180 publications

(243 citation statements)

References 180 publications

Supporting

Mentioning

219

Contrasting

Unclassified

Order By: Relevance

“…At the time of primary infection, a viremia allows the virus to spread to all the organs; blood and organs are potential sources of iatrogenic transmission. During pregnancy, it can be transmitted from mother to foetus, CMV being the most common source of viral congenital infections (0.5–2%) of all live births and the main non-genetic cause of congenital sensorineural hearing loss and neurological damage [ 15 ]. CMV replicates in many cell types, including endothelial cells, epithelial cells, fibroblasts, and monocytes/macrophages.…”

Section: Brief Recalls On the Pathophysiology Of CMV Infectionmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

View full text Add to dashboard Cite

Cytomegalovirus (CMV) infects approximately 40% of adults in France and persists lifelong as a latent agent in different organs, including gut. A close relationship is observed between inflammation that favors viral expression and viral replication that exacerbates inflammation. In this context, CMV colitis may impact the prognosis of patients suffering from inflammatory bowel diseases (IBDs), and notably those with ulcerative colitis (UC). In UC, the mucosal inflammation and T helper cell (TH) 2 cytokines, together with immunomodulatory drugs used for controlling flare-ups, favor viral reactivation within the gut, which, in turn, increases mucosal inflammation, impairs corticoid and immunosuppressor efficacy (the probability of steroid resistance is multiplied by more than 20 in the case of CMV colitis), and enhances the risk for colectomy. This review emphasizes the virological tools that are recommended for exploring CMV colitis during inflammatory bowel diseases (IBD) and underlines the interest of using ganciclovir for treating flare-ups associated to CMV colitis in UC patients.

show abstract

Section: Brief Recalls On the Pathophysiology Of CMV Infectionmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Human CMV establishes a lifelong, latent infection after primary infection, employing multiple mechanisms to evade the immune system [1]. Cytomegalovirus is the most common cause of congenital viral infection, with a prevalence at birth of 0.4-1% [5]. Globally, seroprevalence of CMV infection in women of reproductive age is estimated to be 86% and increases with age [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Role of Congenital Cytomegalovirus Infection in Adverse Birth Outcomes: A Review of the Potential Mechanisms

Njue¹,

Coyne

Margulis³

et al. 2020

Viruses

View full text Add to dashboard Cite

Human cytomegalovirus (CMV) is a major cause of nonhereditary adverse birth outcomes, including hearing and visual loss, neurologic deficits, and intrauterine growth retardation (IUGR), and may contribute to outcomes such as stillbirth and preterm delivery. However, the mechanisms by which CMV could cause adverse birth outcomes are not fully understood. This study reviewed proposed mechanisms underlying the role of CMV in stillbirth, preterm birth, and IUGR. Targeted literature searches were performed in PubMed and Embase to identify relevant articles. Several potential mechanisms were identified from in vitro studies in which laboratory-adapted and low-passage strains of CMV and various human placental models were used. Potential mechanisms identified included impairment of trophoblast progenitor stem cell differentiation and function, impairment of extravillous trophoblast invasiveness, dysregulation of Wnt signaling pathways in cytotrophoblasts, tumor necrosis factor-α mediated apoptosis of trophoblasts, CMV-induced cytokine changes in the placenta, inhibition of indoleamine 2,3-dioxygenase activity, and downregulation of trophoblast class I major histocompatibility complex molecules. Inherent challenges for the field remain in the identification of suitable in vivo animal models. Nonetheless, we believe that our review provides useful insights into the mechanisms by which CMV impairs placental development and function and how these changes could result in adverse birth outcomes.

show abstract

“…A CMV "state of the science" guideline is comprehensive [85]. The natural history of neonates infected with CMV following a maternal primary infection results in symptomatic outcomes (12.7% with 3-4% deaths) and asymptomatic outcomes (87.3% with 86.5% having no sequalae).…”

Section: Discussionmentioning

confidence: 99%

“…Recommended management requires amniocentesis after 17 weeks and 8 weeks after the presumed date of primary infection. For those cases with positive amniotic fluid CMV PCR, maternal management should include valaciclovir 8 g/day until delivery, cordocentesis at 20 weeks for fetal platelet count and CMV/DNA level, US every 2 weeks until delivery, and fetal brain MRI at 32 weeks [85]. Negative results from amniotic fluid CMV PCR and shell viral assay did not completely rule out a neonatal infection with clinical morbidity [86].…”

Section: Discussionmentioning

confidence: 99%

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

Wilson

2020

Fetal Diagn Ther

View full text Add to dashboard Cite

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.

show abstract

Cytomegalovirus infection during pregnancy: state of the science

Cited by 180 publications

References 180 publications

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

The Role of Congenital Cytomegalovirus Infection in Adverse Birth Outcomes: A Review of the Potential Mechanisms

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

Contact Info

Product

Resources

About