Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester: a practical update and counseling aid

Abstract

Cytomegalovirus (CMV) is the most common cause of congenital infection with approximately 0.5% of pregnant women in developed countries seroconverting during pregnancy. In utero transmission occurs in about one third of women who develop primary infection in the first trimester, and these fetuses are at risk for adverse perinatal outcomes and long-term neurological complications. The great promise of a prenatal therapy to reduce fetal infection after maternal primary CMV infection has not been realized to date. The prediction of CMV sequelae is particularly challenging for clinicians because of the heterogeneity of the published literature, the wide spectrum of perinatal outcomes, the adjustment of fetal risk at each stage of assessment, and the variable quality of published data. Given the continued lack of a proven fetal therapy, it is timely to review the natural history of congenital CMV in the modern management era. We have analyzed the recent literature, integrated findings from multiple studies, and calculated stage-specific risks for adverse perinatal outcome to assist in counseling women with first trimester primary CMV infection.

The obstetrician, congenital cytomegalovirus, clinical and diagnostic approaches to the pregnant woman

“…intrauterine growth restriction) with the incidence of foetal morbidity and mortality being highest when transmission occurs during early gestation 2,3 . These key pathological features are similar to congenital HCMV infection 15 .…”

“…Of these, only 25% will have an adverse outcome due to the infection 4,5 . Thus, it is estimated 10% of women with a primary CMV infection in early pregnancy will have a fetus or infant with an adverse outcome 3 . The rate of fetal infection increases with gestation, but the rate of fetal and infant adverse outcomes decreases with gestation 6 .…”

“…These include hearing loss, adverse neurodevelopmental outcomes and in severe cases, fetal death 2 . In first trimester CMV infection, approximately 35% of fetuses will develop CMV infection 3,4 . Of these, only 25% will have an adverse outcome due to the infection 4,5 .…”

“…A negative result before then may be falsely reassuring, and a repeat amniocentesis with a small risk of miscarriage (0.5%), may be required. If the amniotic fluid CMV PCR is negative, the risk of the fetus being infected at birth is small (8%), and the risk of an abnormal outcome is low (~0.5%) 3 . It is well recognised that CMV infection may persist 25 .…”

Comparison of quantitative real‐time PCR and short‐term (18‐hour) microculture in diagnosis of fetal cytomegalovirus infection: Impact of hyperimmunoglobulin treatment

“…The timeframe between acquirement of maternal HCMV infection and amniocentesis (AC) is important concerning sensitivity of the diagnostic tool and also important for risk evaluation of maternofetal HCMV transmission. Risk of miscarriage or severe sequelae of the infant is highest after periconceptional and first‐trimester maternal HCMV primary infections (PI) …”