Abstract
This prospective cohort study aimed to determine clinical factors associated with congenital cytomegalovirus (CMV) infection in pregnancy. Newborns born at a perinatal medical center received PCR analyses for CMV-DNA in their urine with informed consent. Clinical data, including age, maternal fever or flu-like symptoms, complications, ultrasound fetal abnormality, gestational weeks at delivery, and birth weight, were collected. Logistic regression analyses determined clinical findings associated with congenital CMV infection (cCMV). cCMV was diagnosed in 32 of 4380 pregnancies. Univariate and multivariable analyses revealed that age < 25 years old (OR 2.7, 95% CI 1.1–6.6; p < 0.05), the presence of maternal fever or flu-like symptoms (5.4, 2.6–11.2; p < 0.01), ultrasound fetal abnormalities (12.7, 5.8–27.7; p < 0.01), and preterm delivery at less than 34 gestational weeks (2.6, 1.1–6.0; p < 0.05) were independent clinical findings associated with cCMV. A combination of maternal fever/flu-like symptoms, ultrasound fetal abnormalities, or preterm delivery at less than 34 gestational weeks as optimal predictive factors showed 90.6% sensitivity, 66.4% specificity, and a maximum Youden index of 0.57. CMV-DNA tests in the urine of newborns born to mothers with these clinical manifestations may be an effective method in detecting cCMV as a targeted screening with a high sensitivity.
Highlights
This prospective cohort study aimed to determine clinical factors associated with congenital cytomegalovirus (CMV) infection in pregnancy
It was revealed that age < 25 years old, the presence of maternal fever/flu-like symptoms, ultrasound fetal abnormalities, and preterm delivery at less than 34 gestational weeks (GW) were independent clinical findings associated with the occurrence of congenital CMV infection (cCMV) in pregnant women who delivered at a perinatal medical center
This cohort study at a perinatal medical center demonstrated that clinical findings including age younger than 25 years, the presence of fever/flu-like symptoms, fetal growth restriction (FGR), ultrasound fetal abnormalities, premature delivery, earlier gestational weeks at delivery in pregnant women; lighter birth weight and low birth weight (LBW) in newborns were associated with cCMV
Summary
Y.) using the Voluson E8 Expert system (GE Healthcare, Milwaukee, Wisconsin) or the ProSound Alpha 7 system (Hitachi-Aloka Medical, Tokyo, Japan) They underwent measurements of estimated fetal weight by ultrasound at the regular prenatal checkup. The obstetricians collected the clinical data of pregnant women who visited to and gave birth at the university hospital, including age, gravidity and parity, fever or flu-like symptoms, obstetric and medical complications, delivery mode, gestational age at delivery, birth weight, and anomalies of newborns including cardiac malformation, renal dysplasia, intestinal atresia, and chromosomal abnormality. Pregnant women who visited the university hospital were asked to provide informed consent to undergo blood tests for CMV IgG and IgM, and these were measured among enrolled subjects until 22 GW. All statistical analyses were performed using SPSS software, version 19 (SPSS Inc., Chicago, Illinois)
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