CMV in pregnancy: Difference between revisions

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(Created page with "== Background == * Infection with cytomegalovirus during pregnancy * Infection can be primary infection, non-primary reinfection with another strain, or non-primary react...")
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== Background ==
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==Background==
   
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* Infection with [[cytomegalovirus]] during pregnancy
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*Infection with [[cytomegalovirus]] during pregnancy
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* Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus
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*Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus
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* Mainly of concern because of the risk of causing [[congenital CMV]]
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*Mainly of concern because of the risk of causing [[congenital CMV]]
   
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=== Epidemiology ===
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===Epidemiology===
   
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* Maternal seroconversion in about 2% of pregnancies
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*Maternal seroconversion in about 2% of pregnancies
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** Higher in childcare workers
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**Higher in childcare workers
  ⚫
*Affects about 1 in 200 live births in US
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* Risk of transmission to fetus
  
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*Risk of transmission to fetus is highest with maternal primary infection, and much lower for non-primary infection
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** About 1 in 200 live births in US
  
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** '''Primary infection''': 30% risk of congenital CMV; higher risk later in pregnancy, but worse outcomes earlier
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**'''Primary infection''': 30% risk of congenital CMV
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** Non-primary
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**Non-primary:
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*** '''Reinfection''': 5% risk
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***'''Reinfection''': 5% risk
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*** '''Reactivation''': 1% risk
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***'''Reactivation''': 1% risk
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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]]
   
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{| class="wikitable"
⚫
== Diagnosis ==
  
  +
! rowspan="2" |Trimester
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! rowspan="2" |Transmission to Fetus
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! colspan="3" |Severity of Neurological Disease
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|-
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!Severe
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!Mild/Transient
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!None
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|-
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|First
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|30%
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|5%
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|30%
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|65%
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|-
  +
|Second
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|40%
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|0%
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|15%
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|85%
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|-
  +
|Third
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|70%
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|0%
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|0%
  +
|100%
  +
|}
  +
  ⚫
==Diagnosis==
   
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* Serology with IgM and IgG
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*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
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**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months
βˆ’
** IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]
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**IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]
   
 
{| class="wikitable"
  
{| class="wikitable"
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|}
  
|}
   
βˆ’
* Fetal infection is confirmed by amniocentesis sent for PCR
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*Fetal infection is confirmed by amniocentesis sent for PCR
βˆ’
** 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
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**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
   
βˆ’
== Management ==
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==Management==
   
βˆ’
* Counsel mother on risk of fetal infection and subsequent development of congenital CMV
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*Counsel mother on risk of fetal infection and subsequent development of congenital CMV
βˆ’
* 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
   
 
[[Category:Infectious diseases]]
  
[[Category:Infectious diseases]]

Revision as of 13:45, 15 August 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
Trimester Transmission to Fetus Severity of Neurological Disease
Severe Mild/Transient None
First 30% 5% 30% 65%
Second 40% 0% 15% 85%
Third 70% 0% 0% 100%

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
+ – 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
– – 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

  1. ^  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.

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