CMV in pregnancy: Difference between revisions
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* Overall, 20% of infected babies will have permanent neurological sequelae |
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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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Revision as of 01:03, 20 September 2020
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
- 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 | first | 30% | 5% | 30% | 65% | 10% |
| second | 40% | 0% | 15% | 85% | 6% | |
| third | 70% | 0% | 0% | 100% | 0% | |
| Reinfection | overall | 5% | <1% | |||
| Reactivation | overall | 1% | <1% | |||
- Overall, 20% of infected babies will have permanent neurological sequelae
- 50% of those symptomatic at birth and 15% of those asymptomatic
Diagnosis
- Serology with IgM and IgG
| 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
- 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
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.
