Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention

Abstract

Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.

Socio-biologic Predictors of Active Cytomegalovirus Infection Among Pregnant Women in a Low-resource Setting

“…This is similar to 8.1% from a Kenyan study, but much higher than 1.7% found by Korean investigators [11,13], and could represent either primary or recurrent maternal CMV infection. Although variability exists in the appearance/persistence of IgM antibodies after primary maternal infection, and in the sensitivity/specificity of commercial testing kits, the concomitant finding of both anti-CMV antibodies should spur further evaluation [7]. Rates of transmission of CMV after primary maternal infection is about 35% (between 20% and 75%), and < 2% after non-primary/recurrent infection; higher figures have been documented in LMIC with high prevalence of CMV infection [23].…”

“…Thus, primary preventive measures will constitute the mainstay of management of CMV for now. When pregnant women are targeted for primary prevention, there is evidence that CMV infection can be reduced by 80% [7].…”

“…The best methods of establishing a diagnosis of maternal CMV infection are serological tests and virology. Once seroconversion to CMV in a previously seronegative woman is detected, a diagnosis of primary CMV infection can be made [1,7]. However, since a documentation of seroconversion is rarely made (because women are not usually screened before pregnancy), the detection of CMV IgM has been used as a marker of active or recent CMV infection.…”

“…However, since a documentation of seroconversion is rarely made (because women are not usually screened before pregnancy), the detection of CMV IgM has been used as a marker of active or recent CMV infection. Thus, the simultaneous detection of both CMV-IgG and IgM in a screen-naïve pregnant woman may represent a primary infection [7].…”

A randomized controlled trial protocol comparing the feeds of fresh versus frozen mother’s own milk for preterm infants in the NICU

“…During the fresh milk feeding, human milk will be monitored for CMV, and CMV infection associated with human milk will be managed (Fig. 2) [20][21][22][23]. If an event occurs where the standard practice requires stopping feeds, such as NEC, the feeding protocol will be stopped for that patient.…”