OP13.06: The poor performance of prenatal ultrasound screening for congenital CMV infection is a missed opportunity calling for maternal serological screening in the first trimester

Introduction Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries. Objectives This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy. Data sources Electronically searches on databases and hand searches in grey literature. Study eligibility criteria and participants Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2. Results Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients. Conclusions This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus. Systematic review registration PROSPERO CRD42019124342

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Potential Biomarkers for Predicting Congenital Cytomegalovirus Infection

International Journal of Molecular Sciences ◽

10.3390/ijms19123760 ◽

2018 ◽

Vol 19 (12) ◽

pp. 3760 ◽

Cited By ~ 2

Author(s):

Kenji Tanimura ◽

Hideto Yamada

Keyword(s):

Current Knowledge ◽

Invasive Procedure ◽

Immunoglobulin M ◽

Cmv Infection ◽

Serological Screening ◽

Congenital Cytomegalovirus ◽

Neurological Outcomes ◽

Congenital Cmv Infection ◽

Congenital Cmv ◽

Potential Biomarkers

Early diagnosis and treatment of infants with symptomatic congenital cytomegalovirus (CMV) infection may improve neurological outcomes. For this reason, prenatal detection of newborns at high risk for congenital CMV infection is important. A polymerase chain reaction (PCR) assay for CMV DNA in the amniotic fluid is the gold standard for the diagnosis of intrauterine CMV infection; however, amniocentesis is an invasive procedure. Recently, we have found that the presence of CMV DNA in the maternal uterine cervical secretion is predictive of the occurrence of congenital CMV infection in CMV immunoglobulin M (IgM)-positive pregnant women. In contrast, we have suggested that maternal serological screening for primary CMV infection using CMV-specific immunoglobulin G (IgG), the IgG avidity index, or CMV-specific IgM overlooks a number of newborns with congenital CMV infection. We will review current knowledge of the potential biomarkers for predicting congenital CMV infection.

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