Research
Basic science: Obstetrics
Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population

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Objective

To determine contribution of reinfection with new strains of cytomegalovirus in cytomegalovirus seromimmune women to incidence of congenital cytomegalovirus infection.

Study Design

In 7848 women studied prospectively for congenital cytomegalovirus infection from a population with near universal cytomegalovirus seroimmunity, sera from 40 mothers of congenitally infected infants and 109 mothers of uninfected newborns were analyzed for strain-specific anticytomegalovirus antibodies.

Results

All women were cytomegalovirus seroimmune at first prenatal visit. Reactivity for 2 cytomegalovirus strains was found in 14 of 40 study mothers and in 17 of 109 control mothers at first prenatal visit (P = .009). Seven of 40 (17.5%) study women and 5 of 109 (4.6%) controls (P = .002) acquired antibodies reactive with new cytomegalovirus strains during pregnancy. Evidence of infection with more than 1 strain of cytomegalovirus before or during current pregnancy occurred in 21 of 40 study mothers and 22 of 109 controls (P < .0001).

Conclusion

Maternal reinfection by new strains of cytomegalovirus is a major source of congenital infection in this population.

Section snippets

Study population and design

Forty mothers of infants with congenital CMV infection and 109 mothers of uninfected infants were enrolled in the study. These subjects were selected from 7848 mothers of 8047 infants born at 2 maternity hospitals in the municipality of Ribeirão Preto, Brazil, whose infants were screened (85% all live births) for congenital CMV infection (1.1% rate of congenital CMV infection).8, 17 Among 84 mothers of 87 infants (3 twins) who were identified with congenital CMV infection, 58 (69%) were

Results

Mothers of infected and uninfected infants did not differ in age (median, 20 vs 22 years), years of formal education (median, 8 years vs 9 years), exposure to children <2 years of age (14/40 vs 23/109), age of sexual debut (median, 15 vs 16 years), or number of sexual partners (median, 2). When exposure to young children was extended to include children ≤3 years, significantly more mothers of infected infants cared for young children (23/40 vs 37/109; P = .01).

The median gestational age at

Comment

Women from this region of Brazil with evidence of infection with multiple CMV strains, including women acquiring new virus strains during pregnancy, were more likely to deliver congenitally infected infants than women who lacked serologic evidence of infection with multiple CMV strains. These findings provided support for the hypothesis that reinfections with new virus strains were responsible for a significant number of congenital CMV infections in offspring of women from this highly

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    Cite this article as: Yamamoto AY, Mussi-Pinhata MM, Boppana SB, et al. Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. Am J Obstet Gynecol 2010;202:297.e1-8.

    This work was supported by grants from the National Institutes of Health (NIAID AI 49537; Fogarty International Center, R03 TW006480, to W.J.B., and NIDCDDC04162 to S.B.B.) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process no. 02/04166-6.

    Reprints not available from the authors.

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