Pregnancy Outcomes of Mothers with Detectable CMV-Specific IgM Antibodies: A Three-Year Review in a Large Irish Tertiary Referral Maternity Hospital.

Richard J Drew,Joanne O’Gorman,Eibhlín Healy,Maeve Eogan,Patrick Stapleton,Hala Abu,Cillian De Gascun,Wendy Ferguson

doi:10.1155/2015/218080

Abstract

A retrospective audit was performed for all obstetric patients who had positive CMV IgM results between January 2012 and December 2014 in the Rotunda Hospital, Ireland. In total, 622 CMV IgM positive tests were performed on samples from 572 patients. Thirty-seven patients had a positive CMV IgM result (5.9%) on the Architect system as part of the initial screening. Three patients were excluded as they were not obstetric patients. Of the 34 pregnant women with CMV IgM positive results on initial screening, 16 (47%) had CMV IgM positivity confirmed on the second platform (VIDAS) and 18 (53%) did not. In the 16 patients with confirmed positive CMV IgM results, four (25%) had acute infection, two (12.5%) had infection of uncertain timing, and ten (62.5%) had infection more than three months prior to sampling as determined by the CMV IgG avidity index. Two of the four neonates of women with low avidity IgG had CMV DNA detected in urine. Both these cases had severe neurological damage and the indication for testing their mothers was because the biparietal diameter (BPD) was less than the 5th centile at the routine 20-week gestation anomaly scan.

Highlights

Congenital CMV can have devastating consequences for affected infants and their families, as infection can lead to deafness, severe neurological impairment, and learning difficulties
We have traditionally operated a system of testing for CMV seroconversion in certain patient populations, but we do not have a general antenatal or neonatal screening policy
This study has shown that over a three-year period in which there were 26,862 live births >500 g, assuming an Irish Congenital CMV (cCMV) incidence of 0.19% [7], only two of the expected 51 congenitally infected infants were identified over the study period

Summary

Introduction

Congenital CMV (cCMV) can have devastating consequences for affected infants and their families, as infection can lead to deafness, severe neurological impairment, and learning difficulties. Kimberlin and colleagues reported a benefit associated with early antiviral treatment of cCMV, in particular on hearing loss [2]. This treatment increases the need to have a robust screening method in place so that children infected with CMV at birth can be identified. Neonatal screening for CMV infection using the polymerase chain reaction (PCR) on urine or saliva has been shown to be cost effective if a targeted approach is employed [3,4,5,6]. We have traditionally operated a system of testing for CMV seroconversion in certain patient populations (e.g., second trimester miscarriage and intrauterine death or babies born to HIV-infected women or women on immunosuppression during pregnancy), but we do not have a general antenatal or neonatal screening policy

Methods

Results

Conclusion