Abstract
Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.
Highlights
Surveys show that very few women of childbearing age in North America have heard of congenital cytomegalovirus (CMV) infection, are aware of the importance of CMV as a cause of birth defects, or know the likely sources of maternal CMV infection or possible means of prevention[1,2,3,4]
A retrospective study reported that infants who were proven to have congenital CMV infection after a negative test of amniotic fluid were less likely to have significant clinical abnormalities at birth and none (0 out of 47) had long-term sequelae[78]
In two retrospective studies of pregnancies with confirmed maternal CMV infection, high viral load in fetal blood was a predictor of symptomatic fetal and congenital CMV infection, especially when maternal infection occurred in the first trimester[79,80]
Summary
Surveys show that very few women of childbearing age in North America have heard of congenital cytomegalovirus (CMV) infection, are aware of the importance of CMV as a cause of birth defects, or know the likely sources of maternal CMV infection or possible means of prevention[1,2,3,4]. A survey of 305 practicing obstetricians from across the US found that fewer than half counseled patients on the prevention of CMV infection[6]; studies in France and the Netherlands reported significant gaps in knowledge of maternal and congenital CMV infection among providers of prenatal care[7,8]. Clinicians and public health officials struggle to translate knowledge gained from studies into messages and actions that can prevent maternal and congenital CMV infections. CMV is shed in multiple body fluids, including saliva, urine, semen, cervical/vaginal secretions, and breast
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