LB20. Valacyclovir to Prevent Vertical Transmission of Cytomegalovirus After Maternal Primary Infection During Pregnancy

Abstract Background Cytomegalovirus (CMV) is the most common cause of congenital infection in humans. The highest risk of fetal injury follows a maternal primary infection early in pregnancy. Despite the potential for severe fetal injury, to date there are no proven means to prevent viral transmission. Valacyclovir is an antiviral drug proven effective in decreasing the risk for CMV infection among transplant recipients. Valacyclovir is safe for use in pregnancy, and concentrates in the amniotic fluid without accumulating. A dose of 8 g/day creates therapeutic drug levels in the amniotic fluid and fetal blood. Methods This is a randomized, double-blind, placebo-controlled study comprising pregnant women with serologic evidence of primary CMV infection during the periconceptional period and first trimester. After informed consent, patients were randomly assigned to a treatment group (8 g/day of Valacyclovir) or control group (placebo). Treatment was initiated at the time of serological detection, and continued until amniocentesis. The primary endpoint was the rate of vertical transmission of CMV—determined by amniotic fluid CMV PCR. Secondary endpoints included evidence of symptomatic congenital CMV infection—in utero or postnatally. Results One hundred women were recruited, 90 were included in the data analysis; 45 patients received Valacyclovir and 45 placebo. There were 2 twin pregnancies, and therefore 92 amniocentesis Amongst the Valacyclovir group, 5 (11.1%) amniocentesis were positive for CMV, compared with 14 (29.8%) in the placebo group (P GLMM = 0.03), corresponding with an odds ratio of 0.29 (95% CI: 0.09–0.90) for vertical CMV transmission. Amongst patients infected during the first trimester, a positive amniocentesis for CMV was significantly (P = 0.02) less likely in the Valacyclovir arm (2/19) compared with placebo (11/23). No significant differences (P = 0.91) in CMV-positive amniocentesis were observed between study arms amongst patients infected periconceptionally. Conclusion Valacyclovir at a dose of 8 g/day is effective in reducing the rate of fetal CMV infection following early maternal primary infection during pregnancy. The drug reduces the rate of fetal infection by 71%. Disclosures All authors: No reported disclosures.

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Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

Medical Science and Discovery ◽

10.36472/msd.v8i11.623 ◽

2021 ◽

Vol 8 (11) ◽

pp. 650-654

Author(s):

İbrahim Kale

Keyword(s):

Platelet Count ◽

Intrahepatic Cholestasis ◽

Predictive Value ◽

Aspartate Aminotransferase ◽

Alanine Aminotransferase ◽

First Trimester ◽

Control Group ◽

Third Trimester ◽

Apri Score ◽

In Pregnancy

Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP). Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women. Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681). Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.

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An effective and feasible approach to prevention of primary cytomegalovirus infection in pregnancy

Microbiology Australia ◽

10.1071/ma15063 ◽

2015 ◽

Vol 36 (4) ◽

pp. 179 ◽

Cited By ~ 2

Author(s):

Maria Grazia Revello ◽

Valentina Frisina ◽

Giovanna Oggè ◽

Alessia Arossa ◽

Milena Furione

Keyword(s):

Primary Infection ◽

Cytomegalovirus Infection ◽

Seroconversion Rate ◽

Controlled Study ◽

Risk Of Infection ◽

Behavioural Interventions ◽

Primary Cytomegalovirus Infection ◽

Protective Behaviours ◽

In Pregnancy ◽

Close Contacts

In the absence of a cytomegalovirus (CMV) vaccine, other strategies for prevention of primary infection in pregnancy should be considered. Behavioural interventions have been reported to significantly decrease seroconversion rate among seronegative pregnant women. We report here on a recently completed controlled study in which seronegative women at high risk of infection because of close contacts with children <36 months, were identified and informed about risky and protective behaviours. Informed women seroconverted at a significantly lower rate than non-informed women.

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Lamotrigine in pregnancy – therapeutic drug monitoring in maternal blood, amniotic fluid, and cord blood

International Clinical Psychopharmacology ◽

10.1097/yic.0000000000000088 ◽

2015 ◽

Vol 30 (5) ◽

pp. 249-254 ◽

Cited By ~ 8

Author(s):

Michael Paulzen ◽

Sarah E. Lammertz ◽

Tanja Veselinovic ◽

Tamme W. Goecke ◽

Christoph Hiemke ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Amniotic Fluid ◽

Cord Blood ◽

Drug Monitoring ◽

Maternal Blood ◽

Therapeutic Drug ◽

In Pregnancy

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Sertraline in pregnancy – Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood

Journal of Affective Disorders ◽

10.1016/j.jad.2017.01.019 ◽

2017 ◽

Vol 212 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Michael Paulzen ◽

Tamme W. Goecke ◽

Elmar Stickeler ◽

Gerhard Gründer ◽

Georgios Schoretsanitis

Keyword(s):

Therapeutic Drug Monitoring ◽

Amniotic Fluid ◽

Cord Blood ◽

Drug Monitoring ◽

Maternal Blood ◽

Therapeutic Drug ◽

In Pregnancy

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A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia

Acupuncture in Medicine ◽

10.1177/09645284211057567 ◽

2021 ◽

pp. 096452842110575

Author(s):

Dorothy Yuet Tao Ng ◽

Alexandra Lo ◽

Emily Wing Sze So ◽

Grace Ching Yin Wong ◽

Raymond Hang Wun Li ◽

...

Keyword(s):

Pain Relief ◽

First Trimester ◽

Termination Of Pregnancy ◽

Controlled Study ◽

Control Group ◽

Local Analgesia ◽

First Trimester Pregnancy ◽

Nulliparous Women ◽

Group Data ◽

Oral Diazepam

Background: Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. Methods: In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. Results: The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Conclusion: Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

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RISK FACTORS OF HIV-1 VERTICAL TRANSMISSION (VT) AND THE INFLUENCE OF ANTIRETROVIRAL THERAPY (ART) IN PREGNANCY OUTCOME

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652014000200008 ◽

2014 ◽

Vol 56 (2) ◽

pp. 133-138 ◽

Cited By ~ 12

Author(s):

Maria F.M. Barral ◽

Gisele R. de Oliveira ◽

Rubens C. Lobato ◽

Raul A. Mendoza-Sassi ◽

Ana M.b. Martínez ◽

...

Keyword(s):

Risk Factors ◽

Prenatal Care ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Vertical Transmission ◽

First Trimester ◽

Antiretroviral Drugs ◽

Vertical Transmission Of Hiv ◽

Hiv 1 ◽

In Pregnancy

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

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Epidemiology of Cytomegalovirus among pregnant women in Africa

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11373 ◽

2019 ◽

Vol 13 (10) ◽

pp. 865-876 ◽

Cited By ~ 2

Author(s):

Doreen Mhandire ◽

Sarah Rowland-Jones ◽

Kudakwashe Mhandire ◽

Mamadou Kaba ◽

Collet Dandara

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Primary Infection ◽

Significant Risk ◽

Sociodemographic Factors ◽

Reproductive Age ◽

African Women ◽

Bibliographic Databases ◽

Original Research ◽

Cmv Infection

Introduction: Vertical transmission of Cytomegalovirus (CMV), resulting in congenital CMV (cCMV) infection could have disabling and potentially fatal effects on the foetus or neonate. Although primary infection probably has a higher risk of leading to cCMV, in highly seropositive populations, a significant risk of vertical transmission is thought to be due to CMV reactivation and or reinfection during pregnancy. In this narrative review, we summarise the prevalence of CMV infection and associated risk factors among pregnant African women, in a setting where primary CMV infection usually occurs during infancy. Methodology: A systematic search of literature published between January 2000 and January 2019, retrieved on five bibliographic databases was performed. Search for relevant articles was performed using the following keywords: cytomegalovirus, CMV, infection, antenatal infections, pregnancy, pregnant women, gravidity, developing countries and Africa, with appropriate qualifiers such as OR, AND. Results: Systematic searching retrieved 11 relevant original research papers. Prevalence of anti-CMV IgG and IgM antibodies ranged from 60-100% and 0-15.5%, respectively. Prevalence of CMV DNA ranged from 0-29%, depending on the specimen used. However, there was no geographic trend for CMV seroprevalence or CMV DNA prevalence across the African continent. Overall, a substantial percentage of women of reproductive-age were CMV seronegative and at risk of primary infection. Associations of sociodemographic factors with CMV infection were inconsistent across all reviewed studies. Conclusions: The limited data and inconsistency of findings from the few studies carried out in Africa calls for prospective studies comparing prevalence and outcomes of cCMV in infants born to women with both primary and reactivated CMV in Africa.

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Cytomegalovirus Infection in Pregnancy

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744994000554 ◽

1994 ◽

Vol 2 (3) ◽

pp. 146-152 ◽

Cited By ~ 1

Author(s):

Patrick Duff

Keyword(s):

Antimicrobial Therapy ◽

Cytomegalovirus Infection ◽

Preventive Measures ◽

Congenital Infection ◽

First Trimester ◽

Perinatal Infection ◽

Maternal Infection ◽

Cmv Infection ◽

Congenital Infections ◽

In Pregnancy

Cytomegalovirus (CMV) infection is of great importance to obstetrician-gynecologists because maternal infection is relatively common and can result in severe injury to the fetus. The greatest risk to the fetus occurs when the mother develops a primary CMV infection in the first trimester. Forty to 50% of infants delivered to mothers with primary CMV infections will have congenital infections. Of these neonates, 5–18% will be overtly symptomatic at birth. Approximately 30% of severely infected infants die, and 80% have severe neurologic morbidity. Eighty-five to 90% of infants will be asymptomatic, and 10–15% of these babies subsequently have sequelae such as visual and auditory defects. If the mother develops a recurrent or reactivated CMV infection during pregnancy, the risk of a severe congenital infection is very low. Perinatal infection, as opposed to congenital infection, may result from exposure to the virus during delivery or lactation and rarely leads to serious sequelae. Antimicrobial therapy and immunotherapy for CMV are, at present, unsatisfactory. Therefore, all patients, pregnant women in particular, must be educated about preventive measures.

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Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review

PLoS ONE ◽

10.1371/journal.pone.0261011 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261011

Author(s):

Claire Périllaud-Dubois ◽

Drifa Belhadi ◽

Cédric Laouénan ◽

Laurent Mandelbrot ◽

Olivier Picone ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Primary Infection ◽

First Trimester ◽

Secondary Outcome ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

First Trimester Of Pregnancy ◽

Congenital Cmv ◽

Current Practices

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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