Prevention of Maternal–Fetal Transmission of Cytomegalovirus

Stuart P Adler

doi:10.1016/j.ebiom.2015.08.004

Abstract

Reported maternal-to-fetal rates of primary cytomegalovirus (CMV) infection during pregnancy have been between 30% and 50%. The highest rate of symptomatic congenital infection and sequelae occurs in about 25% of infected infants born of mothers with a primary infection during pregnancy. Symptomatic infants demonstrate a constellation of clinical features that reflect placental dysfunction and probable viral infection of the central nervous system of the fetus. In the United States, we estimate that about 8000 affected infants are born each year. Two options may be available to prevent or treat maternal CMV infection during pregnancy, especially for women with exposure to young children in the home. The first is hygienic intervention. Two studies support the simplicity, harmlessness, and effectiveness of hygienic intervention to prevent child-to-mother transmission of CMV among high-risk pregnant women who know they are susceptible. The second is CMV immunoglobulin. A meta-analysis of 2 clinical trials showed an efficacy of 50% if immunoglobulin is given to pregnant women who have acquired a primary CMV infection during pregnancy. These results mean that seronegative pregnant women have options to prevent fetal infection.

Highlights

In the United States approximately 40,000 pregnant women are infected with CMV during pregnancy and probably an equal number in Europe
After a primary infection during pregnancy, the fetal infection rate varies from 33% to 75% as gestation progresses and disease rates may be as high as 50% if infection occurs during early gestation (Bodéus et al, 2010; Nigro et al, 2005)
CMV seronegative health care providers caring for hospitalized young children and infants, are not at an increased risk (Adler, 2010)

Summary

Introduction

In the United States approximately 40,000 pregnant women are infected with CMV (seroconvert) during pregnancy and probably an equal number in Europe. A primary maternal infection with CMV in early pregnancy causes the majority of congenital disease. The majority of seronegative pregnant women acquire CMV from a child less than three years of age in the home or for pregnant women employed in infant day care centers, from children in their care (Adler et al, 2004; Adler, 1989).

Results

Conclusion