Abstract
BackgroundScarce data exist about screening, diagnosis and prognosis of non-primary Cytomegalovirus (CMV) during pregnancy. We aimed to examine antenatal diagnosis of maternal non-primary CMV infection and to identify risk factors for congenial CMV disease.MethodsRetrospective cohort of 107 neonates with congenital symptomatic CMV infection, following either primary (n = 95) or non-primary (n = 12) maternal CMV infection. We compared the groups for the manifestations and severity of congenial CMV disease, as well as for possible factors associated with the risk of developing CMV related infant morbidity.ResultsDisease severity is not similar in affected newborns, with a higher incidence of abnormal brain sonographic findings, following primary versus non-primary maternal CMV infection (76.8% vs. 8.3%, p < .001). Symptomatic congenital CMV disease following a non-primary infection is more frequent if gestational hypertensive disorders and/or gestational diabetes mellitus have ensued during pregnancy (33.3% vs. 9.9%, p <0.038), as well as if any medications were taken throughout gestation (50% vs. 16.8%, p <0.016). CMV-IgM demonstrates a low detection rate for non-primary maternal infection during pregnancy compared to primary infection (25% vs. 75.8%, p = 0.0008).ConclusionNon-primary maternal CMV infection has an impact on the neonate. Although not readily diagnosed during pregnancy, knowledge of risk factors may aid in raising clinical suspicion.
Highlights
Scarce data exist about screening, diagnosis and prognosis of non-primary Cytomegalovirus (CMV) during pregnancy
107 newborns with symptomatic congenital CMV disease were available for final analysis - 12 (11.2%) newborns were symptomatic following non-primary CMV maternal infection and 95 (88.8%) were affected following primary CMV maternal infection
Our results demonstrate that symptomatic newborns following maternal non-primary CMV infection were significantly less likely to present an abnormal brain sonography compared to neonates with congenital CMV disease following primary CMV infection (8.3% vs. 76.8%, p < .001)
Summary
Scarce data exist about screening, diagnosis and prognosis of non-primary Cytomegalovirus (CMV) during pregnancy. We aimed to examine antenatal diagnosis of maternal non-primary CMV infection and to identify risk factors for congenial CMV disease. Non-primary, maternal CMV infection occurs when prior maternal immunity exists. It can emerge following latent CMV reactivation or by a new viral strain reinfection [3]. Following a non-primary maternal infection the vertical transmission rate of CMV is reported to be 0.2-1% [4] and congenital symptomatic disease is diagnosed in less than 1%, among fetuses infected in-utero [5]. Non-primary maternal CMV infection has been previously reported as a cause of congenital symptomatic disease [14, 15].
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