Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany.
Med Microbiol Immunol. 2017 Oct;206(5):347-354. doi: 10.1007/s00430-017-0512-3. Epub 2017 Jul 21.
Congenital cytomegalovirus (CMV) infection is the leading cause for sensorineural hearing loss and mental retardation in children without genetic diseases worldwide. There is little evidence guiding therapeutic strategies during pregnancy when intrauterine fetal CMV infection is confirmed. We provide a systematic review of the use of ganciclovir (GCV) or VGCV during pregnancy discussing safety of its use for mother and fetus and describe two cases of intrauterine therapy of fetal CMV infection with valganciclovir (VGCV). A PubMed database search was done up to November 16, 2016 without any restrictions of publication date or journal, using the following keywords: "valganciclovir" or "ganciclovir" and "pregnan*". Furthermore, citations were searched and expert references were obtained. Reported cases were considered if therapy was in humans and initiation of treatment of the CMV infection was during pregnancy. In total, seven case reports were retrieved which described GCV or VGCV use during pregnancy for fetal or maternal CMV infection. In the four cases of treatment for maternal CMV infection, no negative effects on the fetus were reported. Three cases of GCV administration to pregnant woman with the intention of fetal treatment after proven fetal infection were found. We additionally present two cases of VGCV treatment in pregnancy from our center of tertiary care. VGCV seems to be a safe treatment for congenital CMV infection for the mother and the fetus. Therapeutic concentrations can be achieved in the fetus by oral intake of the mother and CMV replication can be suppressed. Larger studies are needed to evaluate this therapeutic intervention and the long-term effects.
先天性巨细胞病毒（CMV）感染是全球无遗传疾病儿童感音神经性听力损失和智力障碍的主要原因。当宫内胎儿 CMV 感染得到确认时，妊娠期间的治疗策略几乎没有证据指导。我们提供了妊娠期使用更昔洛韦（GCV）或缬更昔洛韦（VGCV）的系统评价，讨论其对母亲和胎儿使用的安全性，并描述了用缬更昔洛韦（VGCV）宫内治疗胎儿 CMV 感染的两例病例。对截至 2016 年 11 月 16 日的 PubMed 数据库进行了无出版日期或期刊限制的搜索，使用了以下关键字：“valganciclovir”或“ganciclovir”和“pregnan*”。此外，还进行了引文搜索并获得了专家参考文献。如果治疗是在人类中进行的，并且在妊娠期间开始治疗 CMV 感染，则考虑报告病例。共检索到 7 例病例报告，描述了妊娠期使用 GCV 或 VGCV 治疗胎儿或母体 CMV 感染。在 4 例治疗母体 CMV 感染的病例中，未报告对胎儿有不良影响。发现 3 例 GCV 给药病例是为了治疗已证实的胎儿感染的孕妇，目的是治疗胎儿。我们还从我们的三级保健中心介绍了 2 例妊娠期 VGCV 治疗病例。VGCV 似乎是治疗先天性 CMV 感染的母亲和胎儿的安全治疗方法。可以通过母亲口服摄入使胎儿达到治疗浓度，并可以抑制 CMV 复制。需要更大的研究来评估这种治疗干预和长期效果。
