scholarly journals 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 ◽  
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

Current practices of management of congenital Cytomegalovirus infection during pregnancy and childhood: systematic review protocol

2020 ◽  
Author(s):  
Claire Perillaud Dubois ◽  
Drifa Belhadi ◽  
Cédric Laouénan ◽  
Laurent Mandelbrot ◽  
Christelle Vauloup-Fellous ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
State Of The Art ◽  
Grey Literature ◽  
The State ◽  
Cochrane Library ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
Congenital Cmv ◽  
Current Practices

Abstract Background: Congenital CMV infection is the first worldwide cause of congenital viral infection and a major cause of sensorineural hearing loss and mental retardation. As systematic screening of pregnant women and newborns is still debated in many countries, this systematic review aims to provide the state of the art on current practices concerning management of congenital CMV infection.Methods: We will perform electronically searches on MEDLINE, EMBASE, Cochrane Library (CENTRAL), ClinicalTrials.gov, Web of Science and hand searches in grey literature. Interventions regarding biological, imaging, and therapeutic management of infected pregnant women, fetuses and neonates/children (from birth to 6 years old) will be studied in this systematic review. Study screening will be performed in duplicate by two independent reviewers and risk of bias will be evaluated with the ROBINS-I tool. Discussion: This review will provide the state of the art of current management of congenital CMV infection in pregnant women, fetuses, neonates and children until 6 years old, in order to have an overview of current practices of congenital CMV infection.Systematic review registration: PROSPERO CRD42019124342

Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection

2012 ◽  
Vol 141 (10) ◽  
pp. 2187-2191 ◽  
Author(s):  
A. Y. YAMAMOTO ◽  
R. A. C. CASTELLUCCI ◽  
D. C. ARAGON ◽  
M. M. MUSSI-PINHATA
Keyword(s):  
Pregnant Women ◽  
Primary Infection ◽  
Congenital Infection ◽  
High Rate ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Younger Age ◽  
Congenital Cmv Infection ◽  
Stratified Sample ◽  
Congenital Cmv

SUMMARYCongenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95·8–98·0), with age-specific (years) prevalence as follows: 12–19 (96·3%), 20–24 (97·7%), 25–29 (97·1%), and 30–46 (96·7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.

scholarly journals P04.04: Is there a neonatal risk from congenital CMV infection beyond the first trimester of pregnancy?

2019 ◽  
Vol 54 (S1) ◽  
pp. 165-165
Author(s):  
S. Lipitz ◽  
T. Elkan Miller ◽  
T. Weissbach ◽  
N. Duvdevani ◽  
E. Katorza ◽  
...  
Keyword(s):  
First Trimester ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
First Trimester Of Pregnancy ◽  
Congenital Cmv

First-line noninvasive management of cytomegalovirus primary infection in pregnancy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Marie Denef ◽  
Laure Noel ◽  
Gaëlle Bruck ◽  
Justine Gudelj ◽  
Malek Tebache ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Primary Infection ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Fetal Outcome ◽  
Cmv Infection ◽  
First Line ◽  
Congenital Cmv Infection ◽  
Magnetic Resonance Imaging Mri ◽  
Congenital Cmv

Abstract Objectives To introduce a first-line noninvasive antenatal management of maternal cytomegalovirus (CMV) primary infection based on ultrasound (US) and magnetic resonance imaging (MRI). Amniocentesis (AC) is used as a second-line tool in cases of abnormalities compatible with fetal CMV infection on US and/or MRI screening. Methods Between January 2011 and October 2018, pregnant women referred with a CMV primary infection on antibody screening were followed up by monthly US scans and a brain MRI at approximately 32 weeks. In cases with US and/or MRI abnormalities compatible with congenital CMV infection, AC was performed to confirm the diagnosis. Results Ninety pregnant women with a primary CMV infection were included (89 singleton and one twin pregnancy). The first-line screening by US and/or MRI was normal for 72 of 91 fetuses (79%). At birth, 19 of these 72 neonates (26%) had a positive urine sample for CMV but were asymptomatic. US and/or MRI abnormalities were identified in 19 fetuses (21%). AC confirmed a fetal CMV infection in 16 fetuses (84%); 12 pregnancies were terminated, and four were continued, with three symptomatic neonates at birth and one poor neurodevelopmental outcome at postnatal follow-up. Conclusions First-line noninvasive management of maternal CMV primary infection based on serial US scans and brain MRI can be offered to identify fetuses with severe symptomatic congenital CMV infection and reduce the number of ACs without compromising the fetal outcome.

scholarly journals Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal

2019 ◽  
Vol 3 (1) ◽  
pp. e000455
Author(s):  
Paulo Paixão ◽  
Maria João Brito ◽  
Daniel Virella ◽  
Maria Teresa Neto
Keyword(s):  
Primary Infection ◽  
Recurrent Infection ◽  
Congenital Infection ◽  
High Avidity ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
Missed Diagnosis ◽  
Congenital Cmv

ObjectiveHuman cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood.DesignInfants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit.PatientsInfants born between 2006 and 2011 with confirmed congenital CMV infection.MethodsMaternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age.ResultsForty confirmed cases of congenital CMV infection were reported (6.6:105 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27).ConclusionThe reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

scholarly journals Intra-uterine transmission of cytomegalovirus in women known to be immune before conception

1984 ◽  
Vol 92 (1) ◽  
pp. 89-95 ◽  
Author(s):  
P. D. Griffiths ◽  
C. Baboonian
Keyword(s):  
Prospective Study ◽  
Pregnant Women ◽  
Congenital Infection ◽  
Infected Child ◽  
Cmv Infection ◽  
Previous Pregnancy ◽  
Congenital Cmv Infection ◽  
Retrospective Testing ◽  
A Prospective Study ◽  
Congenital Cmv

SUMMARYA prospective study identified 785 pregnant women who had been shown to possess complement fixing antibodies against cytomegalovirus (CMV) during a previous pregnancy. As these women were thus known to have been immune prior to their subsequent conception, their neonates were examined for evidence of congenital CMV infection. Specimens were obtained from 725(92%) of the neonatcs and congenital infection was found in only one (0·14%). The elder sister of the infected child was also shown, by retrospective testing of her stored cord serum for specific IgM antibodies, to have been infected in utero. Thus, one woman was identified who had delivered consecutive siblings congenitally infected with CMV. We conclude that some women have a propensity for intra-uterine transmission of CMV, despite being immune prior to conception, and speculate that such women may have acquired their infections perinatally.

scholarly journals Relative Risk Assessment of Intrauterine Infection of the Fetus During Cytomegalovirus Infection in Early Pregnancy

2019 ◽  
Vol 4 (3) ◽  
pp. 45-51 ◽  
Author(s):  
K. K. Petrova
Keyword(s):  
Risk Assessment ◽  
Relative Risk ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Intrauterine Infection ◽  
First Trimester ◽  
Cmv Infection ◽  
Significant Difference ◽  
First Trimester Of Pregnancy ◽  
Relative Risk Assessment

Background. Intrauterine fetal infection (IUI), the common cause of which is the cytomegalovirus (CMV), occupies one of the first places in the structure of perinatal morbidity and mortality. There are no data on the relative risk assessment of IUI at the exacerbation of CMV infection and its delitescent course in first trimester of pregnancy in the literature.Aim: to calculate the relative risks of fetal IUI in pregnant women with exacerbation of CMV infection in the first trimester of pregnancy.Methods. A retrospective review of the labor and delivery medical records and prenatal records of 104 CMV-seropositive women was carried out. Fifty of these women had an exacerbation of CMV infection in the first trimester of pregnancy – main group and 54 of them were with delitescent course of the disease (comparison group).Results. A comparative analysis of ultrasound and morphological markers of IUI with risk assessment depending on the course of CMV infection in the first trimester of pregnancy has been carried out. A high risk of placental structure abnormalities, as well as amniotic fluid and fetal membranes, fetal and placental blood flow pathology, onset of  choroid plexus cyst and fetal growth restriction was found, with a statistically significant difference in the group of pregnant women with exacerbation of CMV infection in the first trimester of pregnancy.Conclusion. The findings suggest that the exacerbation of CMV infection in early pregnancy is a risk factor for IUI.

Congenital cytomegalovirus infection management; what is new?

2021 ◽  
Vol 1 (2) ◽  
pp. 001-007
Author(s):  
Therese-Mary William
Keyword(s):  
Pregnant Women ◽  
Screening Program ◽  
Dried Blood Spots ◽  
Cmv Infection ◽  
Pcr Assay ◽  
Assay Sensitivity ◽  
Congenital Cytomegalovirus ◽  
Congenital Cmv Infection ◽  
Specific Symptoms ◽  
Congenital Cmv

Congenital Cytomegalovirus (CMV) infection is one of major public health concerns and one of the most frequent congenital infections worldwide. Congenital CMV infection is under-diagnosed in the majority of asymptomatic pregnant women due to its self-limited non-specific symptoms and unimplemented screening program. It also can go undetected at birth because in affected newborns are often asymptomatic; however, they manifest serious morbidities later in life. Primary CMV infections are associated with the highest in-utero transmission with estimated rates of 30–35% . Transmission occurs less frequently in secondary maternal infections at approximately 1.1–1.7%. There are growing evidences that early treatment with the antiviral therapy in newborns with congenital CMV infection can reduce sensorineural hearing loss (SNHL) and the substantial long-term neurodevelopmental disabilities. There is increased interest in establishing a prophylactic CMV vaccines that can protect seronegative mothers from primary infection and also to augment the immune response in seropositive women in order to prevent reactivation or re-infection. Saliva PCR assay can be used to screen newborns within the first 3 weeks of age instead of Dried blood spots (DBS), liquid-saliva PCR assay sensitivity is “100%” higher than DBS sensitivity “35%-100%" as not all infants have detectable viraemia at birth. Suggestive strategies to reduce the burden of congenital CMV disease and ensure better outcomes are; establishing a screening programme for pregnant mothers, developing prophylactic CMV vaccines, early therapeutic intervention in pregnant women and newborns and to replace DBS with Saliva PCR assay in screening newborns.

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