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Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age

https://doi.org/10.1016/j.jcv.2011.07.005Get rights and content

Abstract

Background: The risk of intrauterine cytomegalovirus (CMV) infection and disease in the fetus or newborn largely depends on time of primary maternal infection during pregnancy.

Objectives

Prospective cohort study of pregnancy outcome in relation to gestational age at primary maternal CMV infection.

Study design

In a total of 248 pregnancies with primary infection the onset of infection was determined by IgG seroconversion, IgG avidity and/or onset of clinical symptoms. Congenital infection was diagnosed by CMV detection in amniotic fluid, fetal tissue or urine of the neonate in the first 2 weeks of life. Clinical symptoms were retrieved from ultrasound and medical records.

Results

The intrauterine transmission rates following primary CMV infection in the pre- and periconceptional period were 16.7% (4/24) and 34.5% (10/29), respectively. For the first, second and third trimester of pregnancy transmission rates were 30.1% (25/83), 38.2% (29/76) and 72.2% (26/36), respectively. The rate of symptomatically infected fetuses or newborns at birth was 22.8% for any symptoms and 10.3% for severe manifestations. No symptoms were observed in infected newborns of mothers with primary infection in the preconceptional period and in the third trimester.

Conclusions

The risk of intrauterine transmission following primary maternal infection in the third trimester is high, but the risk of neonatal disease is low. The highest risk of severe symptoms in the fetus and newborn exists around conception and in the first trimester of pregnancy.

Section snippets

Background

Age of pregnancy at time of maternal primary cytomegalovirus (CMV) infection is regarded to have a significant effect on intrauterine CMV transmission and symptoms at birth. This is in contrast to Stagno's earlier report, showing similar rates of fetal infection following maternal infection in early or late gestation.1 Recent studies by Bodeus et al. in Belgium2, 3 and Revello et al. in Italy4 investigated the vertical transmission rate in over 500 pregnancies each in relation to onset of

Objectives

We present our findings on the risk of intrauterine transmission according to gestational age at which primary maternal infection occurred. In addition to the cited studies,2, 3, 4 we report on the clinical outcome of congenitally infected fetuses and newborns.

Study design

We have extended our first study on CMV primary infection in 166 pregnancies (from 1990 to 2003)9 with 82 pregnancies (from 2004 to 2010) to a total of 248 pregnancies. All women had experienced a serologically proven primary CMV infection, with timing of infection to gestational age and known outcome of pregnancy. Women were identified in our laboratory in daily routine diagnosis and then prospectively followed up. We assigned cases to one of the following categories according to time of

Results

The results of this study are summarized in Table 1. The mean rate of intrauterine transmission was 37.9%. The rate was significantly higher following maternal infection in the third trimester compared to the first trimester (72.2% versus 30.1%; p < 0.0001, χ2-test). From the 248 pregnancies with serological proven maternal infection ten pregnancies were terminated before gw 15 shortly after diagnosis of CMV primary infection, of which seven fetuses had a proven congenital infection and three

Discussion

Our findings confirm an increased risk for in-utero transmission of CMV in the third trimester as already demonstrated by Bodeus et al.2, 3 and Revello et al.4 Moreover our study adds data to the observation that the risk of symptomatic disease in the fetus or newborn after primary maternal infection in the third trimester of pregnancy is low, since all 26 infected newborns were healthy at birth. From 14 of them (54%) we have obtained follow-up information at age 5 months to 4 years. All

Funding

None.

Competing interest

None declared.

Ethical approval

Not required.

References (14)

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