Congenital cytomegalovirus infection following first trimester maternal infection: Symptoms at birth and outcome
Introduction
Although cytomegalovirus (CMV) is the leading cause of congenital infection in the United States, little is known about the relationship between gestational age at the time of maternal primary infection and clinical expression of fetal infection. Studying the effect of gestational age on the outcome of congenital CMV infection is difficult because it is difficult to define the time of onset of maternal infection. Studies of large cohorts of pregnant women have found that primary CMV infection occurs during pregnancy in around 2% of women, but over 95% of them have no identifiable illness (Ahlfors et al., 1984, Griffiths and Baboonian, 1984, Stagno et al., 1982) information on the effect of gestational age on outcome of congenital CMV infection is of practical prognostic value and is essential for considering strategies for prevention, diagnosis and treatment of infection during pregnancy. In order to determine the effect of gestational age on virulence of fetal infection, we compared the outcome of congenital CMV infection in infants born after a first trimester maternal infection with that of infants born after second or third trimester infection.
Section snippets
Study population
Criteria for inclusion of infants in this report were: (1) Congenital CMV infection proven by isolation of virus prior to 3 weeks of age. (2) Maternal primary CMV infection during pregnancy documented by seroconversion (from serum antibody negative to antibody positive) or detection of serum CMV-IgM antibody on the first prenatal sample. (3) Maternal primary infection could be categorized as occurring during the first trimester (prior to week 14 of gestation) or later (≥14 weeks of gestation).
Detection of primary maternal infection
In order to determine the specificity of the CMV-IgM antibody assay for detection of primary infection, sera from 300 women known to be seropositive for at least 1 year were tested. IgM antibody to CMV was found in 2/300 (1.5%). Among 43 women who seroconverted from CMV-IgG negative to positive, 36 (83.7%) had CMV-IgM in their first positive serum. The mean interval between the last CMV-IgG negative serum and the first positive serum was 30 weeks. When the interval between negative and positive
Discussion
Approximately 20–30% of infants with congenital CMV infection due to a first trimester primary maternal infection will have CNS sequelae. With maternal infection later in pregnancy, the rate of sequelae in infected offspring is lower. However, even third trimester maternal infections are capable of causing hearing loss, a result that is not surprising because progressive deterioration in hearing after birth is a characteristic feature of congenital CMV infection (Dahle et al., 1979, Fowler et
Acknowledgements
This work was supported in part by grants from the National Institute of Child Health and Human Development (P01 HD10699), the National Institute on Deafness and Communication Disorders (K08 DC00079), the National Institutes of Allergy, Immunology and Infectious Diseases (P01 AI-43681) and the UAB General Clinical Research Center (M01 RR00032).
References (27)
- et al.
Increased risk of cytomegalovirus transmission in utero during late gestation
Obstetrics Gynecol
(1999) - et al.
Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection
J Pediatr
(1997) - et al.
Prenatal indicators of congenital cytomegalovirus infection
J Pediatr
(2000) - et al.
Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk
Obstetrics Gynecol
(2000) - et al.
Congenital cytomegalovirus infection: on the relation between type and time of maternal infection and infant's symptoms
Scand J Infect Dis
(1983) - et al.
Congenital cytomegalovirus infection and disease in Sweden and the relative importance of primary and secondary maternal infections
Scand J Infect Dis
(1984) - et al.
Neonatal screening for congenital cytomegalovirus infection by detection of virus in saliva
J Infect Dis
(1993) - et al.
Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity
N Engl J Med
(2001) - et al.
Progressive hearing impairment in children with congenital cytomegalovirus infection
J Speech Hear Disord
(1979) - et al.
Pre- and periconceptional primary cytomegalovirus infection: risk of vertical transmission and congenital disease
BJOG
(2005)