CMV in pregnancy: Difference between revisions
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***'''Reinfection''': 5% risk |
***'''Reinfection''': 5% risk |
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***'''Reactivation''': 1% risk |
***'''Reactivation''': 1% risk |
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*However, due to the much higher number of non-primary infections and reactivations, 75% of congenital CMV occurs in mothers who had non-primary infection |
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*Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially[[CiteRef::enders2011in]] |
*Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially[[CiteRef::enders2011in]] |
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| rowspan="5" |Primary |
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|periconception |
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|5% |
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|first |
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|100% |
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|overall |
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|40% |
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| colspan="2" |13% |
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|78% |
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|Reinfection |
|Reinfection |
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|overall |
|overall |
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|5% |
|5% |
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|overall |
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*Overall, 20% of infected babies will have permanent neurological sequelae[[CiteRef::dollard2007ne]] |
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**50% of those symptomatic at birth and 15% of those asymptomatic |
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==Diagnosis== |
==Diagnosis== |
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*Serology with IgM and IgG |
*Serology with IgM and IgG |
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**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months |
**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months |
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**IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]] |
**IgM has false positives, including from [[rheumatoid factor]], [[EBV]] infection, [[lupus]] |
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==Management== |
==Management== |
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*No clear benefit to use of CMV-targetted antivirals ([[ganciclovir]] or [[valganciclovir]]), and possible risk of gonadal dysgenesis and hematologic toxicity |
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*CMV hyperimmune globulin is promising but not yet in widespread use |
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*Counsel mother on risk of fetal infection and subsequent development of congenital CMV |
*Counsel mother on risk of fetal infection and subsequent development of congenital CMV |
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*If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose |
*If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose |
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== Prevention == |
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* Prevention focusses on lifestyle or behavioural changes that can decrease the risk of primary or non-primary infection |
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** Not sharing food, drink, utensils with young children |
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** Not putting a child pacifier in the mouth |
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** Avoiding saliva when kissing a child |
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** Washing hands properly with soap and water after changing diapers, feeding children, or wiping children's nose or mouth |
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** Not sharing toothbrushes |
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** Cleaning surfaces and toys contaminated with children's urine or saliva |
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* Screening for CMV immunity is not routinely recommended, since 75% of infants with congenital CMV are born to infants with non-primary infection |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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Latest revision as of 12:37, 5 November 2021
Background
- Infection with cytomegalovirus during pregnancy
- Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus
- Mainly of concern because of the risk of causing congenital CMV
Epidemiology
- Maternal seroconversion in about 2% of pregnancies
- Higher in childcare workers
- Affects about 1 in 200 live births in US
- Risk of transmission to fetus is highest with maternal primary infection, and much lower for non-primary infection
- Primary infection: 30% risk of congenital CMV
- Non-primary:
- Reinfection: 5% risk
- Reactivation: 1% risk
- However, due to the much higher number of non-primary infections and reactivations, 75% of congenital CMV occurs in mothers who had non-primary infection
- Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially1
| Maternal Serostatus | Trimester | Transmission to Fetus | Severity of Neurological Disease | Overall Probability
(of any neurological disease) | ||
|---|---|---|---|---|---|---|
| Severe | Mild/Transient | None | ||||
| Primary | periconception | 5% | ||||
| first | 30% | 5% | 30% | 65% | 10% | |
| second | 40% | 0% | 15% | 85% | 6% | |
| third | 70% | 0% | 0% | 100% | 0% | |
| overall | 40% | 13% | 78% | |||
| Reinfection | overall | 5% | <1% | |||
| Reactivation | overall | 1% | <1% | |||
- Overall, 20% of infected babies will have permanent neurological sequelae2
- 50% of those symptomatic at birth and 15% of those asymptomatic
Diagnosis
- Serology with IgM and IgG
- IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months
- IgM has false positives, including from rheumatoid factor, EBV infection, lupus
| IgG | IgM | Avidity | Interpretation |
|---|---|---|---|
| + | β | N/A | past infection, low risk for congenital infection |
| + | + | high | past infection, low risk for congenital infection |
| + | + | low | primary maternal infection within the past 3 months |
| β | β | N/A | either no infection, or repeat in 4 weeks |
- Fetal infection is confirmed by amniocentesis sent for PCR
- To minimized the risk of a false-negative result, it should be be done after 17 weeks gestation and at least 7 weeks after maternal infection
Management
- No clear benefit to use of CMV-targetted antivirals (ganciclovir or valganciclovir), and possible risk of gonadal dysgenesis and hematologic toxicity
- CMV hyperimmune globulin is promising but not yet in widespread use
- Counsel mother on risk of fetal infection and subsequent development of congenital CMV
- If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose
Prevention
- Prevention focusses on lifestyle or behavioural changes that can decrease the risk of primary or non-primary infection
- Not sharing food, drink, utensils with young children
- Not putting a child pacifier in the mouth
- Avoiding saliva when kissing a child
- Washing hands properly with soap and water after changing diapers, feeding children, or wiping children's nose or mouth
- Not sharing toothbrushes
- Cleaning surfaces and toys contaminated with children's urine or saliva
- Screening for CMV immunity is not routinely recommended, since 75% of infants with congenital CMV are born to infants with non-primary infection
References
- ^ Gisela Enders, Anja Daiminger, Ursula BΓ€der, Simone Exler, Martin Enders. Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age. Journal of Clinical Virology. 2011;52(3):244-246. doi:10.1016/j.jcv.2011.07.005.
- ^ Sheila C. Dollard, Scott D. Grosse, Danielle S. Ross. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Reviews in Medical Virology. 2007;17(5):355-363. doi:10.1002/rmv.544.
