Primary Cytomegalovirus Infection in Pregnancy

Abstract

We studied 16 218 pregnant women from two income groups to determine the incidence of primary cytomegalovirus (CMV) infection and its consequences for the offspring. In the high-income group, 64.5% of the women were seronegative for CMV and 1.6% had primary CMV infection. In the low-income group, only 23.4% of the women were seronegative for CMV, but 3.7% experienced a primary infection. The rate of transmission in utero was similar in the two groups (39% and 31%). Congenital infections were more frequent in the low-income group; however, primary CMV accounted for 25% of the congenital infections in this group, in contrast to 63% of the high-income cases. Infections acquired early and late in gestation had similar rates of transmission in utero, but three infants (8%) with symptomatic congenital infection and five infants (13.5%) who have developed significant handicaps were exposed in the first half of pregnancy. Primary CMV infection during pregnancy poses a 30% to 40% risk of intrauterine transmission and adverse outcome is more likely when infection occurs within the first half of gestation.

Utility of newborn screening cards for detecting CMV infection in cases of stillbirth

“…26 The high prevalence of CMV detected in this current study is probably due to the biased in selecting stillborn infants as our study population. Nonetheless, our result was expected as CMV is the most common congenital viral infection 27,28 and has been associated with stillbirths in case reports. 29 It is also possible that using sensitive methodologies (PCR and blood on NBSC), we were able to detect more CMV infections.…”

Management of Pregnancies with Confirmed Cytomegalovirus Fetal Infection

“…Overall, the vertical transmission rate was found to be 20-40% in pregnant women with primary infection and 0.2-2.2% in previously known seropositive women undergoing recurrent infection during pregnancy [33,34,35,36]. Nevertheless, irrespective of the type of infection, severe congenital infections have been reported and it seems that protection provided by a previous CMV infection is only partial [37,38,39].…”

“…In 1986, Stagno et al [34] reported the association between gestational age and the risk of vertical transmission. In this study the authors did not find any difference in the transmission rate when they compared pregnancies where maternal CMV infection occurred between weeks 4 and 22, 16 and 27, and 23 and 40.…”

“…It has been shown that almost all infants with symptomatic congenital infection were exposed in the first half of pregnancy [8,34,42,48]. However, Steinlin et al [49] reported 7 children who presented with a clinical complex of signs (microcephaly, sensorineural hearing impairment, behavior problems, ataxia, hypotonia and developmental problems) and imaging abnormalities (calcifications or dysmyelination) after CMV infection thought to have occurred in the third trimester of the pregnancy.…”

“…None of the latter group had more than one disability, compared with 4 (12%) of the first-trimester group (p = 0.04). An association between outcome and gestational age at the time of maternal infection was suggested in reports in the 1980s by Ahlfors et al [48] and Stagno et al [34], but these included very few cases of congenital infection that could be categorized as first trimesters. More recently, Liesnard et al [8] reached similar conclusions based on a date of fetal infection established by testing of AF and/or fetal blood.…”