Marshall Gary S, Stout Gordon G
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Am J Perinatol. 2005 Oct;22(7):371-6. doi: 10.1055/s-2005-872590.
The incidence of congenital cytomegalovirus (CMV) disease is dependent on the rate of virus acquisition by susceptible women in temporal proximity to pregnancy. Information about serostatus may help to identify high-risk groups and target interventions. Each year from 1991 to 2000, cord blood specimens (surrogates for maternal serum) from 100 consecutive deliveries were obtained at three hospitals. The presence of CMV immunoglobulin G antibody was correlated with demographic data. Overall, 58% of 2992 women were seropositive. After stratification by socioeconomic status (SES), nonwhite race was strongly associated with seropositivity (odds ratio, 3.0; 95% confidence interval [CI], 2.5 to 3.8), and after stratification by race, lower SES also was associated (odds ratio, 2.0; 95% CI, 1.7 to 2.3). There were no trends in seroprevalence over time in any demographic group. However, among white women 21 to 29 years of age, a significant association was found with later birth cohort. Seropositivity ranged from 40% among older, white primigravidas of upper SES to 89% among older, nonwhite, multigravid women of lower SES. These data suggest high rates of CMV transmission among nonwhite women of lower SES. Because these women tended to deliver infants at younger ages, delaying pregnancy even a few years might reduce the incidence of congenital disease. In contrast, most white, upper SES women remain susceptible to primary infection during their childbearing years. Such women born after 1975 may be more likely to reach the childbearing years with CMV immunity as compared with women born before then.
先天性巨细胞病毒(CMV)疾病的发病率取决于易感女性在接近妊娠时感染病毒的速率。血清学状态信息可能有助于识别高危人群并确定干预目标。1991年至2000年期间,每年在三家医院采集100例连续分娩的脐带血标本(作为母体血清的替代物)。CMV免疫球蛋白G抗体的存在与人口统计学数据相关。总体而言,2992名女性中有58%血清学呈阳性。按社会经济地位(SES)分层后,非白人种族与血清学阳性密切相关(优势比为3.0;95%置信区间[CI]为2.5至3.8),按种族分层后,较低的SES也与之相关(优势比为2.0;95%CI为1.7至2.3)。在任何人口统计学组中,血清阳性率均无随时间变化的趋势。然而,在21至29岁的白人女性中,发现与较晚出生队列存在显著关联。血清学阳性率范围从SES较高的年长白人初产妇中的40%到SES较低的年长非白人经产妇中的89%。这些数据表明,SES较低的非白人女性中CMV传播率较高。由于这些女性往往在较年轻时分娩,将怀孕推迟几年可能会降低先天性疾病的发病率。相比之下,大多数白人、SES较高的女性在生育年龄仍易发生原发性感染。与1975年以前出生的女性相比,1975年以后出生的此类女性更有可能在生育年龄时具有CMV免疫力。