Abstract
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.
Highlights
Cytomegalovirus (CMV) is a common cause of congenital infection
These results indicated that a rapid increase in the serum CMV immunoglobulin G (IgG) avidity index was associated with the occurrence of congenital CMV infection among pregnant women with suspected primary CMV infection during pregnancy
These results suggest that universal screening using CMV-specific immunoglobulin G (CMV IgG) avidity measurements in low-risk pregnant women is inefficient for the prediction of congenital infection, because the majority of congenital CMV infection was caused by non-primary CMV infection
Summary
The incidence of congenital CMV infection is reported to be 0.2–2.4% in infants in developed countries [1], and 10–15% of affected fetuses show symptomatic congenital infection at birth. The clinical manifestations of congenital CMV infection, including fetal growth restriction (FGR), low birth weight, and cerebral and multiple organ involvement, can be so severe that they cause major neurological sequelae in about 90% of surviving infants. In the United States, an estimated 40,000 children with congenital CMV infection are born annually, resulting in an estimated 8000 children who have long-term sequelae. If we can develop preemptive strategies for congenital CMV infection, the health and economic burden of the disease can be reduced. This review focuses on current knowledge of the potential biomarkers that may lead to the development of preemptive strategies for congenital CMV infection and disease
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