Abstract
BackgroundIn utero Cytomegalovirus (CMV) vertical transmission occurs predominantly during primary maternal infection. There are no known non-invasive methods for diagnosis of fetal infection before delivery, however some risk factors have been suggested. We aimed to evaluate the association between maternal CMV urinary excretion and congenital CMV infection.MethodsA retrospective cohort study of all women who were diagnosed with primary CMV infection during pregnancy in a single university affiliated tertiary medical center, between 2012 and 2016. We examined congenital CMV infection and disease rates among infants born to women with and without CMV urinary excretion.ResultsOverall, 126 women were included, 77 in the positive urinary excretion group, and 49 in the negative urinary excretion group. There was no difference in maternal symptoms between the groups. We found no difference in congenital CMV infection and disease rates between infants born to women with and without urinary excretion of CMV (congenital infection rate 37.1% vs. 24.4%, p = 0.209, congenital disease rate of 18.2% vs. 22.4%, p = 0.648). Women with positive urinary CMV excretion had lower IgG avidity values (36.7% vs 54.6%, p = 0.007), with no additional difference in serology pattern. Compared to asymptomatic women, those with CMV related symptoms did not have significantly higher rates of urinary excretion of CMV (70% vs. 60.5%, p = 0.38) or congenital infection rates (40.7% vs. 31.2%, p = 0.48).ConclusionAmong infants of women with primary CMV infection in pregnancy, we did not find an association between urinary excretion of CMV and congenital CMV infection.
Highlights
Cytomegalovirus (CMV) is a DNA herpesvirus, established as the most common congenital viral infection, with birth prevalence of approximately 0.5% [1]
126 women met the inclusion criteria and were divided into two study groups according to CMV urinary excretion: 77 (61.11%) women with positive urinary excretion and 49 (38.89%) with negative urinary excretion
We found that the congenital CMV infection rate was higher in the positive urinary excretion group (33.8% vs. 20.4% In the non-excretion group, p = 0.209), the congenital CMV disease rate was lower in this group (18.2% vs. 22.4%, p = 0.648)
Summary
Cytomegalovirus (CMV) is a DNA herpesvirus, established as the most common congenital viral infection, with birth prevalence of approximately 0.5% [1]. The most important protective factor against congenital CMV infection is preexisting maternal immunity against the virus [3], as is the timing of infection during gestation: the rate of vertical transmission in women with primary CMV infection increases with advancing gestational age [4,5,6,7] - from approximately 40% during first trimester [6] to 73.3% for third trimester maternal infection [7]. Several additional risk factors, associated with vertical transmission. Zlatkin et al BMC Pregnancy Childbirth (2021) 21:741 to the fetus and severity of congenital CMV disease, have been described for both primary and non-primary maternal infections, such as high-risk occupation for viral exposure, and abnormal fetal MRI [11, 12]. In utero Cytomegalovirus (CMV) vertical transmission occurs predominantly during primary maternal infection. We aimed to evaluate the association between maternal CMV urinary excretion and congenital CMV infection
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