Cytomegalovirus in Pregnancy: Primary versus Recurrent Infections: a Prospective Cohort Study on 208 Pregnancies

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Cytomegalovirus in Pregnancy: Primary versus Recurrent Infections: a Prospective Cohort Study on 208 Pregnancies.

RAHAV G, GABBAY R, DIAV-CITRIN O, SHECHTMAN S, ARNON J, ORNOY A.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. V-176.
Sheba Medical Center, Tel Hashomer, Israel.

BACKGROUND: Cytomegalovirus (CMV) is the most common intrauterine infection. There is increasing evidence that recurrent CMV in the mother may be a significant cause of congenital disease. We describe our experience with 208 pregnancies with CMV infection in pregnancy. METHODS: Women counseled by the Infectious Disease clinic and the ITIS between 1998 and 2001 concerning CMV in pregnancy were prospectively enrolled and followed-up. Prenatal CMV was diagnosed by serial IgG and IgM serum titers, IgG avidity, amniocentesis and ultrasonographic examinations. All infected neonates were followed-up for 24 months. Pathologic examination was performed on induced abortions. RESULTS: Serologic evidence of primary, recurrent, or undefined CMV infection was found in 88, 36, and 84 women, respectively. In the primary infection group, there were 20, 58, and 10 women in whom the infection occurred within 6 months prior to pregnancy, in the first 20 weeks, and in the last half of pregnancy, respectively. Evidence of vertical transmission was similar in the primary - 30.0%, (include 3 mothers infected before conception) and recurrent - 36.4% CMV infections. Transmission was evident in 15.3% of the undefined group. Congenital CMV was found in 3/82 (3.7%), 4/35 (11.4%), and 2/84 (2.4%) in the primary, recurrent and undefined groups, respectively (p=0.06). Congenital CMV was diagnosed at autopsy in 4 fetuses and by clinical and laboratory findings at birth in additional 5 cases. Four had mental retardation and one was deaf. Two of the mentally retarded children were infected due to recurrent infection in pregnancy. CONCLUSION: Recurrent CMV infection seems to be an important cause of congenital disease. It appears advisable to offer amniocentesis in recurrent maternal CMV infection during pregnancy.







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