Primary cytomegalovirus infection during pregnancy and congenital infection: a population-based, mother–child, prospective cohort study

Abstract

Objective This study assessed maternal cytomegalovirus antibodies, and the occurrence of primary and congenital cytomegalovirus infections, and risk factors of congenital infection after a maternal primary infection. Study design We included 19,435 pregnant women in Japan, who were tested for serum cytomegalovirus antibodies before 20 gestational weeks. Immunoglobulin (Ig) G avidity was evaluated in women with both IgG and IgM antibodies; tests were repeated at ≥28 gestational weeks among women without IgG and IgM antibodies. Result Primary and congenital infections were 162 and 23 cases, respectively. The risk ratios for congenital infection were 8.18 (95% confidence interval: 2.44–27.40) in teenage versus older women, and 2.25 (95% confidence interval: 1.28–3.94) in parity ≥ 2 versus parity ≤ 1. Of 22 live birth congenital infection cases, three had abnormal neurological findings. Conclusion We demonstrated teenage and parity ≥ 2 pregnant women as risk factors of post-primary congenital infection.

Pitfalls in the Serological Evaluation of Maternal Cytomegalovirus Infection as a Potential Cause of Fetal and Neonatal Involvements: A Narrative Literature Review

“…In Japan, universal screening for CMV primary infections among pregnant women is not recommended, though random screening has been conducted in some institutions. Of note, the prevalence of maternal CMV seropositivity and of identified patients with congenital CMV infections in Japan is similar to the corresponding figures reported in other countries [ 74 , 75 ]. Therefore, the author believes that congenital CMV infection in the absence of maternal CMV-IgM antibodies is not a frequent occurrence in Japan.…”

Congenital Cytomegalovirus Infection and Maternal Primary Cytomegalovirus Infection in Universal Newborn Hearing Screening Referral Patients: A Prospective Cohort Study

“…In a maternal CMV antibody screening, low IgG avidity is an indicator of primary infection, whereas IgG seroconversion confirms primary infection. Thus, the incidence rate of cCMV infection in mothers with IgG seroconversion (almost half) is higher than that in those with low IgG avidity (<10%) [10]. However, in this study, the cCMV infection rate was higher in mothers with low IgG avidity relative to those showing IgG seroconversion.…”

“…In maternal antibody screening, CMV-specific immunoglobulin (Ig) G and IgM antibodies and IgG avidities are measured in pregnant mothers. Some previous studies have reported on maternal primary CMV infection in Japan, including ours [8][9][10][11]. In these reports, low CMV IgG avidity or IgG seroconversion to positive results was found in all pregnant women with primary CMV infection.…”

“…The incidence rate of maternal primary CMV infection in the general population is reportedly 1-2% in Western Europe and the United States [1]. Indeed, we reported an incidence rate for primary CMV infection among all serologically screened pregnant women in Mie, Japan as 0.98% (95% CI: 0.85-1.13%) [10,25]. The current incidence rate of maternal primary CMV infection in UNHS referral patients (10.0%) was 10-fold higher than that in the general population.…”

“…We prospectively enrolled neonates with referral results in the first hearing screening at each obstetrical institution in Mie, Japan and collected their fresh urine samples during the first week after birth. We performed a real-time polymerase chain reaction analysis to detect CMV DNA from the samples at Mie University Hospital in Mie, Japan, as previously described [9,10]. Infants with ≥200 copies/mL of CMV DNA in fresh urine samples were diagnosed with cCMV infection.…”